Friday, September 27, 2013

Ileostomy Reversal Operation

Dr. Muzammil Irshad, Dr. Khalid Javed,
Dr. Add-ur-Rehman (left to right)
Dr. Khalid Javed is a post-graduate registrar (PGR) and medical officer (M.O.) in surgical ward (when he was in surgical ward 5) at Nishtar Hospital Multan. He is a slick and smooth surgeon (PGR), observes cool and calm personality. He is one of the jolly persons in ward 4 (NHM).
I use to enjoy his puns. Today, he performed ileostomy reversal operation through laprotomy as the previous operation notes were not available. The operation went smooth and easy. No doubt he is learning better surgical skills.

What is ileostomy?

Ileostomy is an artificial opening in the bowel which diverts feces and flatus to the exterior where they can be collected into a bag and then discarded. In 1952, Brooke described the eversion technique and thus ileostomy creation and care was revolutionized.
Additionally, trained nurse enterostomal therapists are helping a lot to educate and care for the patients with ostomies. Usually, ileostomy is made in right lower abdominal region (right iliac fossa).

What are the indications of ileostomy operation?

  • Severe inflammation or obstruction of the gut distal to stoma
  • Ulcerative colitis
  • Familial adenomatous polyposis
  • Total colonic Hirschsprung’s disease
  • Total colectomy for carcinomas
  • Crohn’s disease (occasionally)
  • Multiple ileal perforations
  • Ileal gangrene
  • Distal fistula
  • Distal sepsis

Ileostomy reversal operation

What are types of Ileostomy?

  • End ileostomy
  • Loop ileostomy
  • Double barrel ileostomy

When Ileostomy begins to work?

Ileostomy usually begins to work in 48 hours. Usually, 200 to 700 ml per day is discarded through ileostomy.

How to offer Ileostomy Care?

Dr. Khalid Javed
Ileostomy care is an important issue in patients with ileostomy in order to avoid dehydration and obstruction. The patients with ostomies are advised to drink plenty of water and take antidiarrheal agents to decrease output volume. Patients are warned not to take fibrous or hard diet as it can make indigestible bolus that can obstruct the ileostomy.
Shortly, ileostomy bag, ileostomy care, nutrition and electrolyte balance are very important in the beneficial and healthy management of the patient. Living with ileostomy becomes easy if proper ileostomy care is offered.

How to relieve Ileostomy obstruction?

Take 50ml of warm saline and irrigate the ostomy with the help of Foley’s catheter inserted beneath the fascia along with Intravenous fluids and nasogastric decompression. This technique can relieve the obstructed ilostomy and make it able to work.
As a matter of choice, one can perform water-soluble contrast enema that can open the obstruction or it will, at least, help to diagnose the cause of obstruction.
Cell surfing after ileostomy reversal

What are ileostomy complications?

  • Prolapse
  • Diarrhea
  • Excoriation
  • Stenosis
  • Hemorrhage
  • Retraction
  • Parastomal hernia
  • Spillage of contents
Keywords: Ileostomy repair operation, Ileostomy indications, Ileostomy care, Ileostomy complications

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