Procedural Guide For Colostomy Cases

- اعداد

دليل الأقسام الداخلية

تحت اشراف

-        أ.د/ محمد لطيف   الرئيس التنفيذي للمجلس الصحي المصري     - د/ كوثر محمود نقيب عام التمريض المصري – عضو مجلس الشيوخ

اعداد

- The Professional Oath

"I swear by Almighty God that I will be sincere in my work, fear God in my profession, respect its laws and regulations, and perform my duties with competence and dedication. I will rely on the knowledge derived from nursing sciences in my work, and I will strive to care for those entrusted to me, preserve their dignity, keep their secrets, defend their rights, and protect them from harm. I will not fear to speak the truth, and I will provide a safe environment for the patient, family, and society. I will continue to develop myself, honor and respect my teachers, cooperate with my colleagues on righteousness and piety. God is my witness to what I say."

- Vision and Mission of Nursing Care

• Vision of Nursing Care: The nursing staff in the internal patient care unit aims to elevate the nursing profession and provide effective, safe, and quality nursing care to patients, in accordance with Egyptian, national, and international standards.
• Mission of Nursing Care: The nursing staff in the internal patient care unit is committed to improving the health level of patients and providing them with the best nursing care in line with the hospital's objectives and nursing management procedures. They also work on advancing the scientific and practical levels of all nursing staff in the unit and changing their attitudes toward modern trends in nursing and medical sciences.

- Definition of Colon and Rectum

The colon is a long tube-like organ in the abdomen and is the longest part of the large intestine. It carries waste products to be expelled from the body. The rectum forms the last few centimeters of the colon.

Colon Resection: Colon resection is a surgical procedure to remove all or part of the colon. The colon is part of the large intestine and is a tube-like organ located at the end of the digestive system. Colon resection (colostomy) can be either temporary or permanent and is necessary for treating diseases, particularly tumors.

- Types of Colon Resection Surgeries

1. Total Colon Resection: Involves the removal of the entire colon.
2. Partial Colon Resection: Involves removing a part of the colon, also called subtotal colectomy.
3. Hemicolon Resection: Involves removing the right or left part of the colon.
4. Colon and Rectum Resection: This procedure removes both the colon and rectum.

Colon resection often requires additional procedures to reconnect the remaining parts of the digestive system and allow waste to leave the body in a normal way.

Partial Colon Resection Procedure: In this procedure, the surgeon removes the affected part of the colon along with a small portion of the surrounding healthy tissue. The surgeon then reconnects the cut ends of the colon so that waste can exit the body normally. In some cases, it may be necessary to connect the colon to an opening in the abdominal wall (stoma), where waste collects in a bag attached to the opening. This opening is usually temporary, but it may remain permanent in some cases.

Illustrative Images:

• Image (1): Shows the structure of the colon.
• Image (2): Shows the partial colon resection procedure.

Colon Resection Procedures

Colon resection surgeries may be recommended by a doctor for various conditions affecting this part of the body. The colon is the longest part of the large intestine and plays an important role in helping remove certain fluids and nutrients before solid waste is formed in the stool and excreted from the body. Colon surgeries are performed to address various problems, such as:

• Colon cancer
• Diverticulitis, which refers to small, swollen pouches that may form in the lining of the digestive tract, typically in the lower part of the large intestine.
• Removal of stool obstruction
• Inflammatory bowel disease (IBD)
• Treatment of injuries or bacterial infections in the colon

- Colostomy vs. Ileostomy

A stoma is a surgical procedure that creates a new passage for stool to exit the body when the normal, natural route is unavailable. If the digestive system cannot pass food waste to the rectum and through the anus, an alternative route for waste elimination is necessary.

• Colostomy: A surgical procedure where the colon is attached to the abdominal wall.
• Ileostomy: A surgical opening (stoma) brings a part or end of the small intestine (specifically the ileum) to the surface of the skin. Waste is expelled through this stoma into a collection bag attached to the skin.

Images (3) and (4) illustrate these procedures.

- Nine Types of Colon Surgeries

Colon surgery types vary depending on the medical necessity and the location within the colon. Here are some common types of colon surgeries:

Right Hemicolectomy

This is the first type of colon surgery where the right half of the colon is removed. This procedure involves removing the ascending colon, which connects to the end of the small intestine. The surgeon then sutures the remaining parts of the small intestine to the transverse colon. Conditions that may require this surgery include:

• Diseases or injuries
• Diverticulitis
• Cancer
• Inflammatory bowel disease (IBD)
• Polyps, which may become cancerous

Image (6) shows the procedure of right hemicolectomy.

Left Hemicolectomy

This surgery is primarily used to treat colon cancer and may also be recommended for other conditions, including inflammatory bowel disease (IBD), diverticulitis, or ruptures. In this procedure, the descending colon, which is connected to the rectum, is removed. The surgeon then sutures the transverse colon to the rectum. Image (7) shows the left hemicolectomy procedure.

Partial or Subtotal Colectomy

In a subtotal colectomy, only a portion of the colon is removed, and the ends of the remaining colon are reconnected. The surgeon removes one-quarter to one-third of the colon. This procedure is used to treat colon cancer, IBD, trauma, polyps, or diverticulitis.

Low Anterior Resection

Low anterior resection is a type of colon surgery used to remove rectal cancer. In this surgery, the portion of the rectum that contains cancer is removed. The surgeon then reconnects the remaining part of the large intestine to the rectum, allowing normal stool passage.

Perineal Resection

Perineal resection is a common type of colon surgery to remove cancer from the rectum or anus. During this surgery, the following are removed:

• The rectum
• The anus
• The lower part of the colon

Since the rectum and anus are removed, the surgeon will create a stoma at the end of the colon, which may be temporary or permanent, and it will be covered by a bag that collects stool. The stoma is typically managed through colostomy care.

Total Proctocolectomy

This surgery involves the removal of both the colon and rectum. After removing these parts, the body needs a new way to eliminate stool. In cases of IBD, such as Crohn’s disease or ulcerative colitis, a ileostomy is often performed. In this procedure, part of the small intestine is brought through the abdominal wall to form a stoma, and stool exits the body through this stoma, collected in a pouch worn on the outside of the body. The ileostomy may be temporary or permanent, depending on the circumstances.

If you need more information or further clarifications, feel free to ask!

Colon and Rectum Surgeries

Sigmoid Colon and Rectum Resection

This type of surgery, shown in Image (8), involves the removal of the sigmoid colon and rectum. It is typically recommended for certain diseases or cancers affecting the sigmoid colon or rectum.

J-Pouch Surgery (Ileal Pouch-Anal Anastomosis - IPAA)

A common procedure performed following or during a colectomy (removal of the colon) is the Ileal Pouch-Anal Anastomosis (IPAA), also known as J-pouch surgery. In this surgery, the end of the small intestine (ileum) is fashioned into a "J" shape to serve as a temporary reservoir for stool. This pouch acts similarly to a rectum and is connected to the anus, enabling the patient to have regular bowel movements. This procedure is typically performed for patients with ulcerative colitis, although it can also be used for certain Crohn's disease cases.

Ileal Pouch Anal Anastomosis (IPAA)

Another surgical option is the Ileal Pouch Anal Anastomosis (also called the pull-through procedure). After the colon and rectum are removed, a section of the small intestine is connected directly to the anus. This procedure is often done in conjunction with a temporary ileostomy until healing is complete. The connection is designed to restore bowel function and allow the passage of stool through the anus, with a temporary diversion for waste until the pouch heals.

Total Colectomy

A total colectomy involves the removal of the entire colon but may leave the rectum in place. This procedure is often performed for conditions such as ulcerative colitis or Crohn’s disease. A J-pouch or ileostomy is commonly created to allow the patient to eliminate waste. If the rectum is also removed, an ileostomy is often performed as part of the total colectomy. After this surgery, stool can be passed via the anus or through the stoma, depending on the extent of the procedure.

- Post-Colectomy Care: When to Contact a Doctor

Patients who have undergone a colostomy should consult their doctor under the following circumstances:

• If the skin around the stoma turns an unusual color or becomes painful.
• If the stool has a foul odor.
• If a part of the intestine protrudes from the stoma.
• If symptoms of obstruction, such as vomiting, increasing abdominal pain, or bloating without passing gas, occur.
• If the patient develops a fever with no apparent cause.

Complications After Colostomy Surgery

1. Necrosis: Tissue death around the stoma may occur, and the stoma may appear dark 24-72 hours after surgery. This condition requires surgical intervention to prevent infection or perforation.
2. Stoma Retraction: The stoma may retract into the abdomen, which can result from surgical error or excess weight gain. A surgical revision may be required to reposition the stoma.
3. Stenosis (Narrowing): Stoma narrowing can occur at the skin level, causing discomfort during stool passage. This can be treated through dietary changes, cleaning, and dilating the stoma.
4. Prolapse: This occurs when the intestine protrudes from the stoma, often due to surgical issues or reduced blood flow. After the patient leaves the hospital, the stoma can be managed using a loop colostomy or a support belt to prevent further complications.

- Nursing Care for Colostomy Patients

Goals of Nursing Care:

- References

• United Ostomy Associations of America (UOAA): Website
• International Ostomy Association (IOA): Website
• "Living with a Colostomy: A Guide to Self-Care and Well-Being" by Barbara J. Summers
• "The Ostomy Book: A Guide to Living Well with an Ostomy" by Bettye R. Young and William R. Young
• "The Ostomy Handbook: A Comprehensive Guide to Living Well with an Ostomy" by David B. Scholes
• National Institutes of Health (NIH): NIH Book
• Mayo Clinic: Mayo Clinic Website