Milagros Castro Romera Hospital Universitario de Canarias

 Surgically created opening.  Derivation of the bowel tract to the outside of the abdomen.

 Colostomy  Ascending  Transverse  Descending  Sigmoid  Ileostomy

Immediate OedemaHemorrhageIschemia, necrosisInfection, sepsisStoma retractionDehiscenceEvisceration Late StenosisHerniaProlapseTumor recurrence Skin complications Periestomal dermatitis UlcerationsGranulomasParaestomal varicesIntestinal fistulas

Stoma complications. Complications of mucocutaneous junction. Peristomal skin complications

D is colouration E rosion T issue Overgrowth

Physiological inflammation of the intestinal mucosa as a result of the manipulation of the surgical procedure.

 Rare complication (2-3%)  During first hours after operation  Caused by a subcutaneous o submucosal vein injury.  Late bleeding due to a small wound or coagulation factors alteration

 Evaluate: time of appearance, quantity, origin and hemodynamic status.  Clear pouch (two-pieces system).  Hygiene  Local hemostasis or manual compression.  Mucosa: silver nitrate, adrenaline  Arterial surface: suture

 Problems of blood supply.  Gradual color change  First 24 h  Establish the affected area.  Conservative or surgical treatment

 Colour  Extent of necrosis  Funcionality

 Asepsis  Symptoms: pain, inflammation, suppuration, fever  From peristomal inflammation to abcess.

Vigilance Clear pouches Abcess Drain Regeneration Hydrocolloid powders

 Sinking of the stoma below skin level.  Causes:  Little mobilization  Increased patient weight  Septic complications Peristomal

 Infection and removal of intestinal loop.  Nursing Cares:  Isolate the stoma.  Secondary intention.  Suture.

 Exteriorization of an intestinal segment through the abdominal hole.  Isolate the area with wet sterile gauzes until the surgery.

Peristomal dermatitis Stoma EffluentNutrition General condition Hygiene Materials Caregyver

 Chemical irritant dermatitis  Mechanical dermatitis  Allergic contact dermatitis

 Characteristics  Cause  Extend and degree  Appropiate pouch  Hygiene  Protective creams, powders hydrocolloids  Change brand of device  PREVENTION

Small fleshy mass appearing around the stoma resulting from a persistent skin irritation caused by sutures not removed in time or rubbing the mucosa with the edge of the device.

 Artificial communication between two cavities or between a hollow viscera organ and skin.  Classification:  Internal / enteroenteric  External / eenterocutaneus  Diagnosis:  Surgery  Methylene blue  Barium enema / GDS  Fistulography  CT

Nutritional controlPharmacotherapySepsis controlControl drainageSkin caresPhysical and mental well-being

 Reduction of light reaching the stoma output difficult stool.  Partial  Total  Nursing cares:  Diet  Digital expansion  Irrigations

 Incisional hernia that allows protrusion of abdominal contents through the abdominal  Cares  Evoid efforts  Flexible pouching systems  Stop irrigation  Surgical treatment

 Bowel protrudes through the stomal opening in the skin to a greater extent than was anticipated.  Causes:  Oversized hole  Increased abdominal pressure  Excesive exertion  Infants  Obesity

 Control evolution  Cold saline compresses  Avoid fhysical efforts  Manual technique  Surgery