Untitled Notes

Temporary stomas are created to divert or reroute the fecal stream due to diseases affecting the intestines downstream.
- Conditions requiring a temporary stoma include intestinal blockage or perforation requiring time to repair or heal.
A stoma may become permanent if organs downstream are permanently damaged.
- This is typically the case when the anal sphincter muscle is involved, preventing stool control, or if it is impractical to reconstruct a pouch.

One major type of ostomy is the loop colostomy.
- In this procedure, one end discharges fecal matter, while the other end is non-functional and only discharges mucus.
Loop colostomies are often temporary constructs. They are preferred over end colostomies when there is an intention to reverse the procedure later.

Main indications for creating a temporary stoma include:
- Relieving distal obstruction (often a palliative procedure, such as in cases of rectal cancer).
- Diverting fecal matter from a newly performed distal anastomosis further down the intestinal tract.

The best form of a stoma typically protrudes about 2.5 centimeters from the abdominal wall.
Stoma retraction can occur when the stoma recedes about 0.5 centimeters below the skin surface.

Stoma retraction may arise from several factors:
- Tension of the intestines.
- Obesity, particularly affecting the initial post-operative period.
- Poor blood flow or nutritional status prior to surgery.
- Stenosis or early removal of any supporting devices.
- Stoma placement in deep skin folds or thick abdominal walls.
A retracted stoma usually exhibits a concave or bowl-shaped appearance, which complicates pouching and can lead to skin complications and excoriation.

Typical therapy for a retracted stoma involves:
- Utilizing a convex pouching system which helps accommodate the stoma shape.
- Patients may require a stoma belt for better retention and stability.
If issues persist, a stoma revision may be necessary due to recurrent skin problems from leakage.

A flush stoma can also present challenges for skin care.
- Proper placement of the flange becomes difficult, increasing the risk of skin excoriation.
- Persistent excoriation may necessitate surgery for repair.

A stoma prolapse occurs when the stoma moves or becomes displaced, causing a segment of the bowel to slide through the stoma orifice.
- This displacement can give the appearance of telescoping, increasing the stoma's length and size.
Prolapse may be related to retraction or the presence of a peristomal hernia.
Unless the patient experiences pain, circulatory issues, or bowel obstruction, treatment is generally conservative.

Conservative treatment techniques include:
- Reducing the prolapsed stoma when the patient is in a supine position.
- Using a hernia support binder for stabilization.
- A stoma shield may also be employed to protect the stoma area.
A prolapsed stoma often requires a larger pouch to accommodate its increased size.
Some clinicians may use cold compresses or apply sugar on the stoma as osmotic therapy, although its effectiveness remains unproven.

Adequate blood flow and tissue perfusion are crucial for maintaining stoma health.
- Deficient blood flow can lead to stoma necrosis.
Causes of necrosis can stem from:
- Surgical complications involving excessive tension or mesenteric trimming.
- Vascular causes like hypovolemia or embolism.
- Excessive edema can also compromise blood flow.

Stoma necrosis typically manifests within the first five post-operative days.
- Signs include discoloration (cyanotic, black, dark bluish, purple, or brown), moisture with a shiny appearance, along with possible hardness or flaccidity of the mucosa.
- A foul odor may accompany necrosis, with potential complications like retraction or peritonitis.
Immediate reporting of these symptoms to the physician is essential as it constitutes an emergency situation.
- Superficial necrosis may resolve with sloughing of necrotic tissue, but deeper tissue involvement warrants immediate surgery.