Anus praeternaturalis

Anus praeternaturalis (unnatural anus) - created online by artificial fistula colon, through which stand out faeces; the operation of its imposition - colostomy. Permanent anus praeternaturalis impose more often when radical surgery for cancer of the rectum or as a palliative measure when newdecimal tumors, temporary - severe (mainly firearms) injuries of the rectum, the inversion of the sigmoid colon with already beginning gangrene.
anus praeternaturalisoverlapping anus praeternaturalis - sigmoid colon, at least - the higher departments of the colon. Intestine intersect transversely, and both its end is sewn into the wound of the abdominal wall - double-barreled anus praeternaturalis (Fig. 1.). Create it in palliative operations, as well as in cases, when the anus praeternaturalis impose temporarily, as it facilitates subsequent recovery in the continuity of the colon. Double-barreled anus praeternaturalis may be imposed as a pre-event to radical delete operation of the rectum. Single-anus praeternaturalis, with vivarium in the wound only leads to the end of the colon, impose, if the discharge of its removed to the anus or too short and it is not without tension to bring to the wound (for example after extensive resection of ulcers, dead when inversion). In this case, the discharge end of the tightly sewn and immersed in the abdominal cavity (Fig. 2.).
If there is no acute obstruction of the intestines and is not needed immediately to ensure their evacuation, then double-barreled anus praeternaturalis create in two steps: making median laparotomy (see) and selecting where to overlay the anus praeternaturalis, display gut through a small incision in the left iliac region and fixed glass rod or a strip of gauze, conducted through its mesentery. The corners of the wound sutured. Cross the intestine in 2-4 days, when she spauda with parietal peritoneum. A selection begins Kala, requiring a change of bandages.
After stoma need to thoroughly protect the skin from irritation, frequent change of bandages.
The skin with alcohol, put a thick layer of zinc-oxide paste or paste Lassara. At each dressing change remove balls dry faeces and mucus, then balls soaked in warm soapy water or 0.25% solution of ammonia, wash off the top contaminated layer of ointment (not to skin!), add fresh creams and dressings. Section along the midline of the abdomen to the removal of the stitches need to protect individual label.
Defecation is made through the leading end of the large intestine; over the discharge end washed off part of the bowel (for example, solution of potassium permanganate 1 : 1000-1500 of mugs esmarkha; Fig. 3) and inject the drug.
Single-anus praeternaturalis impose, bringing the end of the ulcer in a very small hole and placing a colon to the parietal peritoneum; derived part of the intestine pinch the soft pulp of 1-2 days (until the fusion). We must remember that the patient under a bandage is a metal instrument with a careless removal of the bandage can damage the gut.
At constant anus praeternaturalis patient has to wear a colostomy bag or belt-band with a bandagecovering the intestinal lumen. When imposing the anus praeternaturalis by way lembras speaker out quite long end of the intestine is covered with skin, cut from the abdomen, close to the removal of the colon. The resulting "proboscis" can be firmly pressed bandage to the abdominal wall. This prevents continuous leakage of stool. Cm. also Intestinal fistula.

Anus praeternaturalis (unnatural anus) is created by complete intersection of the large intestine with vivarium in the wound of the abdomen wall of one (leading) or both its ends. When Hu A. R. lower end cross intestine removed or sew purse string suture and lowered into the abdominal cavity. When double-barreled A. R. through leading end out the contents and gases, and the discharge is to wash the intestine and introduction of medicinal substances.
A. R. impose: as the final stage abdomino-perineal amputation colon or rectal cancer; when newdecimal tumors of the colon (double-barreled anus); resection of dead loop sigmoid colon due to inversion; extensive destruction or injury of the rectum to diversion of feces out (double-barreled A. R.); sometimes with operations concerning a fistula between the stomach and the colon (as a result of chronic ulcers after gastroenterostomy) at extremely malnourished patients, and as a temporary event when atresia of the rectum. In acute intestinal obstruction caused cancer of the sigmoid colon, produce resection of the colon and output single-anus (obstructive pulmonary resection for Rankine).
Most often the Anus praeternaturalis impose in the left iliac region on the sigmoid colon (if necessary mobilizing the descending colon), sometimes on the transverse colon, as an exception - by the blind and rising.
The simplest technique blend double-barreled A. p. when Setting laparotomy its necessity, do a slanting cut in the left inguinal-iliac region and output loop sigmoid colon. In the mesentery make a small window and in it put the glass tube, which lies across the wounds on the skin of the abdomen and keeps the colon outside. The corners of the wound sutured. Of 2-4 days, when the loop spaevaet with the parietal peritoneum, it crossed across, getting double-barreled Anus praeternaturalis. Instead of a glass wand through the mesentery can be U-shaped flap of skin. And in this case also of 2-4 days intestine cross and receive a double-barreled A. R. (Fig. 1).
DC single-Anus praeternaturalis display left iliac region at the level of the belly button or a little lower to close it bandage attached to the belt. After abdomino-perineal amputation rectum causing the end of the sigmoid loop output through a small slash iliac incision with razdvigaya muscles. The opening in the abdominal wall do no more than require the thickness of the output of the loop, so there is a hernia. Four seams intestine is stitched to the parietal peritoneum. At the end of the intestine left soft clip on one-two days. In the future, use colostomy bag or belt-band with a bandage, abdurasoul A. R. and preventing permanent allocation of feces. Plastic surgery create Anus praeternaturalis, equipped with a likeness of the sphincter muscle, rarely used because they can lead to complications.
Widespread way lembras. In the left iliac region are giving U-shaped flap length of 15 cm and a width of 10 - 12 cm with the base, located along the inguinal ligament. At the base of the flap angle cut reveal the fascia and pushing the muscles, reveal the peritoneum. The proximal end of the cross-ulcer take 10-12 cm and cover flap of skin (Fig. 2). Holding Kala is achieved by pressing proboscis to the skin of the abdomen. If you want to destroy a single-A. R. and restore normal intestinal permeability, produce laparotomy, pre outlining the hole gut slit and being sutured her tightly. Exposing the belly angle cut, separated with the colon from the anterior abdominal wall, found in the pelvis distal stump cancer and impose an anastomosis between the leading and outlet end.

Fig. 1. Double-barreled anus. Intestinal loop with painted skin bridge; left bottom - cutting out the bridge when the incision of the skin; the bottom right is the view formed anus.
Fig. 2. Single-anus - the left-hand section of the skin to generate long-term single-anus; on the right is the view formed anus.