Role of Emergency Gastro Intestinal Ostomies in Present Scenario

Sathish, V T (2009) Role of Emergency Gastro Intestinal Ostomies in Present Scenario. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Intestinal stomas are an integral part of gastrointestinal surgery. An intestinal stoma is an opening of the intestinal or urinary tract onto the abdominal wall, constructed surgically or appearing inadvertently. A colostomy is a connection of the colon to the skin of the abdominal wall. An ileostomy involves exteriorization of the ileum on the abdominal skin. In rare instances, the proximal small bowel may be exteriorized as a jejunostomy. Stomas may be life saving in the treatment of bowel perforation or severe sepsis. The burden of care to support and counsel these patients is considerable. Although short term support is needed for patients with temporary stoma, the impact on life is considerable. Stomas may need to be permanent for treatment of low rectal cancer or crohn’s disease. 1. To evaluate the epidemiology of emergency gastro intestinal ostomies. 2. To analyse the various etiology and commonest cause for emergency ostomies. 3. To study the various types of ostomies made. 4. To study the complications of ostomies. 5. To evaluate the morbidity and mortality of patients after ostomy. MATERIALS AND METHODS: This is a prospective study of 42 patients for whom emergency gastrointestinal ostomy was done, in the Department of General Surgery, Government Royapettah Hospital, Kilpauk Medical College, Chennai. All the patients who underwent emergency gastro intestinal ostomy were studied prospectively, their demographic details, clinical features, past medical history, indications for surgery and type of ostomy performed, post operative complications, duration of stay in hospital and outcome. The study period was 25 months from September 2006 to September 2008. Admissions were carried out from outpatients department or through the casualty department as cases of acute abdomen. Majority of these patients (86.60%) presented with abdominal distention, tenderness and abdominal rigidity. There was marked dehydration and toxemia especially in those who presented late in the course of illness. Immediate resuscitative measures were taken in all the patients regardless of age and sex. This comprised maintenance of intravenous line, nasogastric suction, catheterization, intravenous broad spectrum antibiotics and intravenous fluids. The principal diagnostic tools in all the patients were a detailed history and examination, basic blood biochemistry investigations, x-ray chest and x-ray abdomen erect and supine view. The other sophisticated investigations would not be done as majority of patients were taken up for emergency surgery, after due resuscitations laprotomy was performed by a midline incision, and depending upon the intraoperative findings and severity of contamination, type of ostomy was decided. Inclusion All patients who required gastrointestinal ostomy in emergency abdominal surgery were included in the study. Exclusion: Elective surgeries in which ostomies made were excluded Emergency / Elective procedures like feeding jejunostomy / gastrostomy were excluded. CONCLUSION: 1. Patients presenting with peritonitis and severe contamination constitute the most common indication for ostomy, followed by patients with malignancy presenting as intestinal obstruction. 2. Ileal perforation was found to be the most common cause for patients presenting with peritonitis who needed ostomy. 3. Ileostomy, especially split ileostomy, the most common ostomy performed. 4. Peristomal ulceration (skin irritation) – was found to be the most common complication of ostomy. 5. Ostomy was found to be a life saving procedure especially so in moribund patients presenting late in the course of illness.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Emergency Gastro Intestinal Ostomies ; Present Scenario.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 17:37
Last Modified: 06 Jun 2018 01:42

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