OSTOMY
(meaning an external small or large intestinal opening for stool exit)
There are several diseases for which an ostomy may be necessary and vary by age group:
Infants:
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Adolescents:
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Other:
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INFANTS
Hirschprung's Disease
Hirschsprung's (HIRSH-sproongz) disease is a condition in which there are missing nerve cells in the muscles of part of the infant's colon, usually the rectum and/ or sigmoid colon. Another name for Hirschprung's is colonic aganglionosis. The result of lack of nerve innervation is stool being unable to pass through the colon, thus creating a blockage and the colon becoming enlarged with stool. The condition is generally diagnosed after the infant has been unable to have a bowel movement in the first days of life.
The treatment for Hirschprung's Disease is surgery to bypass or remove the non-functional portion of the colon, and possibly creation of a colostomy. One potential complication for babies with Hirschprung's Disease is enterocolitis. Enterocolitis is a serious, life-threatening condition in which, as stool collects in the colon, the collecting stool puts pressure on the blood vessels. Compressed blood vessels results in block blood flow to the gut. With the decreased blood flow to the area, the mucosal lining of the colon breaks down, making it susceptible to infection. |
Necrotizing Enterocolitis (NEC)
According to Gephart, McGrath, Effken, & Halpern (2013), Necrotizing Enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). The onset of NEC is rapid and deadly. Contributing factors including Hirschprung's Disease, prematurity and formula feeding. Treatment entails surgery to remove the necrotized bowel. While the bowel is healing an ostomy may be necessary.
Imperforate Anus
Imperforate anus is a condition in which the anus does not have an external opening. The rectum may connect to another body part, such as the vagina or urinary bladder, through which stool may exit. In female infants with imperforate anus, there is usually one large opening connecting the rectum, bladder, and vagina. To create a functioning anus, stool needs to be rerouted while the new channel is healing. This is done through an ostomy.
Home Care of your child after an ostomy
ADOLESCENTS
Inflammatory Bowel Diseases (IBD) - Crohn's Disease and Ulcerative Colitis - are the primary reasons for adolescents needing an ostomy. Surgical intervention for IBD is based on location of the inflammation in the intestines, how long it has been a problem, and response to prior therapies. Surgery is performed only after multiple medications have been tried.
Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis is limited to the colon (
Crohn's Disease
Crohn’s disease can affect the full thickness of the bowel wall. With Crohn's Disease there can be sections of healthy bowel between areas of inflammation.
Ulcerative Colitis
Ulcerative Colitis (UC) only involves the innermost lining of the colon. Unlike Crohn's Disease, UC is continuous through a section of the colon.
Teen Chat: You and Your Ostomy |
Ostomy Care |
Types of ostomies:
End - A portion of the bowel (small intestine) is divided into two separate pieces. The end closest to the mouth (the "proximal" end is brought to the outside of the body through a hole in the abdominal wall. That end is stitched to the skin. The other end, the end closest to the rectum (or "distal end) is sewn together and left inside the abdomen.
Double-barrel ostomy - same as an end ostomy, except that the distal end of the bowel is also brought through the abdominal wall, but through a separate hole. The two ostomies are side-by-side, thus called "double barrel." The proximal stoma produces stool and the distal stoma, also referred to as a mucus fistula, produces only mucus.
Loop - A loop of bowel is brought through the abdominal wall. "This loop of bowel is cut, on the top, halfway through. The cut edges are turned back, like a cuff, and stitched on the skin" (WOCN, 2013).
Non-functional end is a mucus fistula
Double-barrel ostomy - same as an end ostomy, except that the distal end of the bowel is also brought through the abdominal wall, but through a separate hole. The two ostomies are side-by-side, thus called "double barrel." The proximal stoma produces stool and the distal stoma, also referred to as a mucus fistula, produces only mucus.
Loop - A loop of bowel is brought through the abdominal wall. "This loop of bowel is cut, on the top, halfway through. The cut edges are turned back, like a cuff, and stitched on the skin" (WOCN, 2013).
Non-functional end is a mucus fistula
OSTOMY ASSESSMENT
Your assessment should include:
- Location: jejunum, ilium, or colon, including ascending, transverse, or descending colon
- What kind of stoma it is: end, double-barrel end, or loop
- A description of the stoma's appearance - size, shape, and color
- Stoma function (is it producing stool?)
- Peristomal skin - intact skin, erythema, denuded, candidiasis
Note any abnormalities or complications: if the stoma is protruding or retracting,
Possible post-op comlications include: ischemia, hemorrhage, mucocutaneous separation, parastomal hernia, prolapse, retraction, stenosis, fisula, trauma
Scenario |
Ostomy products |
Assignments:
- Read ostomy booklet
- Watch ostomy video
- Attend a bedside ostomy teaching session
- Become familiar with ostomy products and supplies
- Become familiar with the process of ordering ostomy supplies