Enterostomy

Enterostomy is the operation of superposition of external fistula in the small intestine for artificial feeding of the patient or bring the intestinal contents. In the lumen of the small intestine into the soft rubber tube, which end is output through additional incision in the abdominal wall and fix the silk sutures to the skin. Enterostomy can be made on the jejunum and ileum.
The imposition of the fistula in thin intestine (eyestone) is usually made for supply of the patient.
Eurostone shown in total defeat stomach tumor or extensive burn it. The patient can be fed on the next day after the operation. Warm liquid food pour in through the funnel 100-150 ml 2-3 hours. Feeding must end with the introduction of tea or water, which washed the tube. Then end of a tube knotted and fixed bandage. Sometimes intestinal contents and food mass seep between the pipe and the wall of the fistula, polluting the bandage and macerarea the skin. This often occurs from a mismatch of the tube diameter and width of the fistula. In this case, the receiver needs to be replaced. With the introduction of the tube should not be used effort, as you can perforate the intestine or take it from the abdominal wall.
The imposition of the fistula to the ileum (ileostomy) often produce for the permanent evacuation of intestinal contents when running peritonitis, after an operation for intestinal obstruction, chronic intestinal paresis. After an ileostomy tube should be left open and the outer end of its drop into a clean bottle to the bowel accumulated gases and liquid contents. Under favorable course of the basic disease tube 5-8-day and extract. Fistula in ileostomy often close itself, less often it is necessary to close quickly.
Complications of enterostomy - discharge intestine from the abdominal wall and the development of peritonitis, lack of Hermeticism fistula and maceration of the skin, abscess of abdominal wall, long nasazhivaniya fistula, adhesive process in the abdominal cavity.
Cm. also, Intestinal fistula, Fistulas.

Enterostomy (from the Greek. enteron - intestine and stoma - hole, pass - operation imposing artificial outdoor fistula small intestine - enterostomy. Enterostomal produce mainly for unloading small intestines from overflowing their content or for insertion in the intestines of nutrients. Enterostomy can be produced as a Supplement to another, the principal, the operation while it is in or in the postoperative period. In the latter case, enterostomy called secondary.
Nelaton (A. Nelaton) first described by overlaying enterostomy on the principle duboveneko fistula. Disadvantages of this type of enterostomy (maceration and irritation of the skin around the stoma, the need to quickly closing it) prompted a number of surgeons to make additions and changes in equipment operation. It is known more than ten modifications of enterostomy. The most successful was the method of the so-called suspension enterostomy.
This modification is designed for creation of temporary intestinal fistula. Equipment operation is as follows. The elected necessarily loose loop of the small intestine from two sides pinch soft terminals to the contents after opening the skylight pollute the abdominal cavity. Against the place of discharge of the mesentery impose a silk purse string suture on the plot of 1,5 cm in diameter (Fig., 1). In the centre sheathed plot pierce the wall of the intestine; a small hole into which enter the drainage tube with a diameter of 0.8 cm side hole. 5 cm from the end of the tube stitch or tie thin Katsutoshi thread and fixed to one edge of the intestine (figure, 2), and then ends Katsutoshi threads are cut off and the tube purse string suture invalidinput in the cavity cancer (Fig., 3). Thus, the drainage tube is fixed to the intestine one ketotofin seam inside and silk purse string suture outside. The free end of the drainage tube output through a small opening in the abdominal wall, specially punctured on the outer edge of the vagina rectus, through aponeurotic layers. If fistula impose on skinny colon, then a tube is better to display on the outer edge of the left straight muscles above the navel, if the terminal ileum something right. Fed drainage tube is fixed silk suture to the rubber collar (ring, cut off from the tube), put on drainage skin, flush with the latter (Fig., 4). Thus, intestinal loop is pulled to the abdominal wall.
Hanging enterostomy it was used during the great Patriotic war of the wounded in the stomach. It later turned out that when this modification of the intestine may deviate from the abdominal wall, which will inevitably lead to peritonitis. To avoid this complication should be intestine around the tube addition to commit to the peritoneum separate the silk sutures.

the imposition of a suspension enterostomy
The stages of imposition of suspension enterostomy: 1 - purse string suture on the wall of the small intestine; 2 - fixing drainage to the cut edge of the intestinal wall; 3 - tightening the purse string suture; 4 - fixing drainage for the cuff to the skin.


Depending on the affixing of enterostomy distinguish eurostone - fistula jejunum and ileostomy - fistula ileum. To the formation of each type of fistula there are certain indications.
Eyestone is mainly used for feeding patients, for example in case of divergence between the duodenal stump after resection of the stomach, in the extensive damage the stomach tumor or burn stomach when it is impossible to make gastrostomy.
In case the time anotomy for the power supply used the above technique overlay. The operation is usually performed from the top middle or top left of transrectal incision put a rubber tube is installed in the discharge direction of the knee.
For the permanent anotomy apply the method of Maidla (egregiously anastomosis cross-loops of intestine) or Mayo - Robson (interventionists impose between his knees filed to the anterior abdominal wall loops). Both methods are relatively complex and not applicable in debilitated patients.
In the lower parts of the small intestine enterostomal produce in order bowel evacuation from the liquid contents and gases to combat existing paralytic ileus (for example, common launched peritonitis, severe postoperative bowel paresis) and for unloading the overflowing of the intestine after elimination of mechanical obstruction. Less ileostomy is made in order to prevent possible enteroparesis after various operations.
Unlike eurostogai, the tube is introduced into leading knee loops of intestine and output in a separate small cut to the right or to the left of the midline prevent scurvy and subsequent divergence of seams of the main operational access. In cases where ileostomy is applied a second time, in connection with a progressive ileus, it should make a small incision in the lower abdomen. Under favorable for the need fistula on 5-8th day off, and the tube is extracted, which is enough to cut off the skin seam. The remaining fistula is most often independently closes. At long stay rubber tubing fistula healing is difficult and you have to close it with surgery.
Created intestinal fistula, even in the most advanced version, may be accompanied by serious complications, the main of which are: the discharge of intestine from the anterior abdominal wall and the development of peritonitis, long nasazhivaniya fistula, leading to the progressive depletion of the patient, festering and divergence main incision in the result of infection of enterostomy, development phlegmon of the anterior abdominal wall, the formation of adhesions in the abdominal cavity in the place of launch tubes, bleeding from the gastrointestinal fistula.
Because of these complications indications for imposing an ileostomy decreased significantly. Instead of enterostomy in practice became time-consuming method of extraction of the contents through a thin probe is inserted through the nose, for the treatment of gastro-intestinal stasis. Cm. also the Intestine (operations).