|
Colostomy is the operation of opening into the colon, or lower portion of the intestine. This procedure is one of the most important in abdominal surgery. It is sometimes necessary as a life- saving measure. It may be temporary or permanent as an artificial anus in the radical treatment of rectal cancer. Because of its appearance, its inconvenience and the very thought of an artificial opening in the abdominal wall a great deal of care is necessary to allay the anxieties of patients and their relatives when colostomy is necessary.
In some cases of acute intestinal obstruction the surgeon explores the abdomen and finds perhaps a large mass in the region of the pelvic colon or rectum that cannot be removed. An emergency colostomy is then performed in the transverse colon with the immediate purpose of saving life and with the further objective of providing temporary drainage should the growth be removable at a later date. In some such cases, when at first sight the primary cause of the obstruction seems beyond any possibility of surgical removal, after several weeks of colostomy drainage the infection subsides and the affected portion of bowel may then be removed. Colostomy may be necessary as a preliminary to other operations involving removal of the large bowel. Such an occasion arises if diverticulitis has produced vesico-colic fistula (between the colon and bladder). In some cases of severe incontinence due to abnormality or injury to the anus, a left iliac colostomy enables the patient to be free of the terrible inconvenience of perpetual soiling in the perineum. Injuries or abnormalities of the spinal cord produce paralysis of the anal sphincter mechanism and sometimes colostomy is essential. Congenital absence of the rectum or anus requires an emergency colostomy within a day or so of birth.
There are two main forms of colostomy. First is the loop colostomy which has two limbs. The opening is at the apex of the loop and the bowel has not been divided completely across. A variation of the loop colostomy is the double- barrel form in which the two limbs of the loop are separated by a piece of skinrafter complete division. This is also described as a defunctioning colostomy as it prevents the spill of faeces from the proximal to the distal loop. A second variety is the spur colostomy where a spur is formed by suturing the two ends together for several centimeters inside the abdomen. This is of particular value if the colostomy is temporary as the spur can be destroyed by a crushing clamp without risk of peritonitis or perforation since the limbs have become sealed together. When the spur breaks down, the artificial opening on the surface shrinks and sinks back below the skin level. The aim is that this should close spontaneously without further operation. The third type is the terminal colostomy in which the distal portion of bowel is removed completely or in the case of excision of rectum the lower end is closed to form a blind end. In grave emergencies the simplest form of colostomy is performed in which a loop of colon is brought out through the abdominal wall, where it is held by the insertion of a glass rod passed through a small hole in the mesentery. The ends of the glass rod are connected by a loop of rubber tubing which forms a 'bucket handle' . The abdominal wall is closed around the protrusion of the colostomy. Exteriorisation is another way of performing a colostomy. If a growth is present in a part of the bowel which can be brought readily through the abdominal wall (e.g. transverse or pelvic colon) the affected loop containing the growth is left outside and the peritoneum, muscles and skin are closed around the base of the loop where the two limbs converge. The loop of colon containing the growth is then removed, leaving two open ends of
el which can later be joined by crushing the spur between them. This operation avoids the handling of growth or unprepared bowel while the peritoneal cavity is open and so diminishes the risk of peritonitis. A formal operation for closure is required if a spur has not been made.
At the end of the operation a small incision is usually made in the apex of the loop to allow the immediate discharge of gas and faecal material which is collected as cleanly as possible before the patient leaves the theatre. A dressing of petroleum jelly gauze or tulle gras is applied on the exposed bowel. The skin incision may be sealed with Whitehead's varnish and a pad of cellulose tissue and wool is bandaged lightly over the opening. For fear of contaminating the abdominal wound before the peritoneal cavity has become sealed, the former practice was to leave the colostomy unopened for 48 hours. The initial opening may be enlarged by the surgeon two or three days after the colostomy has been raised. The bowel is usually divided (without anaesthetic) by an electric cautery which seals the blood vessels and prevents bleeding from the very vascular mucous membrane and muscle wall of the bowel. A method of draining the colostomy is by the use of Paul's tube. This is an angled wide glass tube which is inserted through a hole in the colostomy loop. It is tied in position in the same way as the caecostomy catheter and connected to a bedside jar with wide, thin, latex tubing.
 Research Colostomy
The term falx describes a curved fold or process of the dura mater or the peritoneum. The term is especially applied to one of the partition-like folds of the dura mater which extend into the great fissures of the brain.
Research Falx
The omentum is a long fold of the peritoneum. It is loaded with fat and lies in front of the bowels in the abdominal cavity. It protects the bowels and keeps them warm.
Research Omentum
The peritoneum is a complex, serous membrane lining the lower abdominal cavity. Its function is to provide a lubricating surface against which the viscera may move so that they are not damaged by friction. In the male body, the peritoneum is predominately a closed, sac-like structure, while in the female, the fallopian tubes penetrate the peritoneum. The peritoneum contains the lesser cavity at the upper abdomen, near the stomach and transverse colon. The duplicating folds of the peritoneum are called omenta. The greater omentum is the largest of these and hangs down from the stomach over the small intestine. The greater omentum is composed of highly vascularized and innervated fatty tissue, protecting the lower viscera from shock and infection.
Research Peritoneum
The spleen is a solid organ lying between the left wall of the stomach and the diaphragm, protected by the lower ribs and held in position by its capsule which is formed of peritoneum. Its very large artery comes almost directly from the aorta and its vein is one of the main tributaries of the portal system. The spleen has many functions which are known and probably others which are not known. It contains smooth muscle and is capable of contracting. It has a sponge-like structure in which the sinuses or spaces of the sponge are filled with blood. By its power of contraction it is able to expel into the circulation a large amount of this reserve blood, to meet sudden demands such as may be produced by shock or haemorrhage. In addition to this reservoir function, the spleen is the 'headquarters' of the reticulo-endothelial system. Cells of this system are found in various parts of the body, the liver, lymph glands and bone marrow. The function of the reticulo- endotheliai system with its macrophage cells is to deal with foreign particles which circulate in the blood or gain entrance to the tissues, such as bacteria, viruses and other tissue cells. Red blood cells are being continuously destroyed in the spleen. It is probable that antibodies against disease are also produced by the reticulo-endothelial system and by the masses of lymphatic tissue to be found in the spleen.
Research Spleen
In surgery, tapping is an operation to remove a dangerous accumulation of fluid. The term is chiefly applied to the removal of fluid from the pleura or peritoneum, and the operation is performed by withdrawing the fluid by way of a small pipe inserted into the cavity.
Research Tapping
|
The Probert Encyclopaedia was designed, edited and programed by
Matt and Leela Probert
©1993 - 2009 The Probert Encyclopaedia
Southampton, United Kingdom
|
|
|
Abbreviations
