ARE TEMPORARY STOMAS HELPFUL TO MANAGE COMPLEX WOUNDS? Rosine van den Bulck BRUSSELS

Transcription

1 ARE TEMPORARY STOMAS HELPFUL TO MANAGE COMPLEX WOUNDS? Rosine van den Bulck BRUSSELS

2 WHY TEMPORARY STOMAS? Patient AGE AGING POPULATION CO MORBIDITIES OVERALL CONDITION MULTIPLE SURGICAL PROCEDURES POOR SURGICAL, HEALING CONDITIONS SURGERY EMERGENCY SURGERY DIFFICULT TO MANAGE STOMAS/WOUNDS

3 WHY TEMPORARY STOMAS? Surgery diagnosis Diagnosis,RMN, Ultra sounds.. Mini invasive surgery anesthesia Improved quality of anesthesia Mechanical staples anastomosis Low sutures, anastomosis protection Temporary stoma

4 WHY TEMPORARY STOMAS? Type of stoma

5 WOUND COMPLICATION RISK FACTORS Distribution of risk factors (n=117) Risk factors Cases Dehiscence % Old age (>50 years) % Smoking % Obesity % Malnourishment % Malignancy % Post-operative ileus % Chest complications % Wound infection % Post-operative vomiting % Waqar et al, 2005

6 INCIDENCE OF ABDOMINAL WOUND COMPLICATION Any patient undergoing a surgical procedure is at risk of developping wound complications Age, use of steroids, chemotherapy, Rxtherapy, diabetes predispose to wound complications Incidence is higher after laparotomy, emergency surgery

7 CLINICAL CASES

8 Organ Dysfunction Abdom inal Hypertension INTRA ABDOMINAL PRESSURE Normal Abdominal Pressure Abdominal Compartment Syndrome Intra-abdominal Pressure (mmhg)

9 INTRA ABDOMINAL HYPER PRESSURE LATE DECOMPRESSION

10 Intra abdominal Hyperpressure MONDAY 10am Wednesday Wednesday4 pm

11 EMERGENCY SURGERY IMMUNO SUPPRESSIVE TREATMENT CAECUM PERFORATION FAECAL PERITONITIS, FISTULAS laparotomy DELAYED HEALING ILEOSTOMY KIDNEY TRANSPLANT

12 CAECUM PERFORATION ILEOSTOMY SMALL BOWEL FISTULAS SKIN PROTECTION POUCH PARENTERAL NUTRITION

13 CHILDREN IMPERFORATED ANUS

14 Temporary colostomy

15 CHILDREN; TEMPORARY COLOSTOMY NO APPLIANCES NO SKIN DISORDERS

16 TEMPORARY ILEOSTOMY IN OBESE PATIENTS ANASTOMOSIS PROTECTION NO APPROPRIATE APPLIANCES AVOID RIGID CONVEXITY

17 SURGERY FOR SMALL BOWEL CANCER OLD LADY WITH ARTERITIS LAPAROSCOPIC SURGERY MAJOR HAEMATOMA IN EARLY POST OP BOWELS ISCHAEMIA SECOND SURGICAL PROCEDURE LAPAROTOMY + ILEOSTOMY RECURRENCE OF BOWELS ISCHAEMIA TOTAL DEHISCENCE+STOMA NECROSIS

18 SMALL BOWEL ISCHAEMIA RECURRENCE ON STOMA explore the stoma

19 SMALL BOWEL ISCHAEMIA RECURRENCE ON STOMA TOTAL STOMA DEHISCENCE Surgical emergency RECURRENCE OF PRIMARY DISEASE, ARTERITIS

20 FOURNIER s GANGRENE ACUTE AND SEVERE MULTI BACTERIAL INFECTION HAPPENS VERY OFTEN AFTER ABDOMINAL OR PERINEAL SURGERY INCIDENCE IS HIGHER IN MEN WITH DIABETES and OVER SIXTIES SURGICAL DEBRIDEMENT URINE AND STOOLS DIVERSION DEPENDING ON WOUND LOCALISATION ANTIBIOTHERAPY WOUND MANAGEMENT

21 FOURNIER s GANGRENE

22 FOURNIER s GANGRENE

23 AFTER DEBRIDEMENT

24 STOMA, BLADDER CATHETER, NPWT

25 FOURNIER s GANGRENE REVERSAL SURGERY WHEN PERINEUM WOUND IS HEALED

26 NECROTIZING FASCIITIS 60 YEARS OLD LADY COUPLE OF YEARS AGO, MULTIPLE SURGICAL PROCEDURESWITH MAJOR COMPLICATIONS HYSTERECTOMY ABDOMINAL HYPER PRESSURE SMALL BOWL FISTULA 2 ND DAY POST OP ILEOSTOMY SKIN NECROSIS IN PERISTOMAL ZONE MALODOUR

27 Necrotising fasciitis after hysterectomy exposed bowels PRIORITY; BOWELS PROTECTION ILEOSTOMY TO BYPASS FISTULA POUCHING PROBLEMS STOMA CLOSE TO THE WOUND

28 NECROTIZING FASCIITIS AFTER 12 DAYS OF NEGATIVE PRESSURE THERAPY «ABTHERA»

29 MAJOR WOUND COMPLICATION 71YEARS OLD MAN OBESE 160kg 2005 PROSTATE CANCER TREATED BY BRACHETHERAPY SMALL BOWEL RESECTION + UROSTOMY FISTULA IN POST OP ILEOSTOMY RENAL FAILURE IN POST OP WOUND INFECTION TISSUE NECROSIS

30 COMPLICATION POST BRACHYTHERAPIE INFECTION PLAIE+ FISTULE

31 COMPLEX ABDOMINAL WOUND UROSTOMY AND ILEOSTOMY NEGATIVE PRESSURE+WOUND INSTILLATION

32 STOMAS TO MANAGE THE WOUND EMERGENCY SURGERY

33 Conclusion When planning the care of patients with complex abdominal wounds and stoma consideration must be given to : psychological and social needs of the patient The effect of altered body image The patient motivation to comply with wound and stoma management

34 THANK YOU FOR YOUR ATTENTION