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Case sharing after ostomy
2024-05-16
Personal physical problems and inaccurate nursing methods will cause complications after stoma surgery. Of course, complications are not terrible, and effective measures should be taken in time to find out. Let me share with you a postoperative case of ostomy, please take a look with me.
Case:
an uncle in his 60s in the customer group asked for help. More than a year after the operation, he found a lump in his stomach next to the stoma, which was obvious when he was standing, but not when he was lying down.
Below is a picture he took:
It can be seen from the picture above that this is one of the most common complications after stoma surgery - parastomal hernia.
Parastomal hernia is one of the most common postoperative complications of enterostomy. It is caused by the lateral prolapse of the small intestine or colon through the stoma due to various reasons. The etiology of parastomal hernia includes many factors.
So what is a parastomal hernia ?
The U.S. parastomal hernia care guidelines point out that any factors that increase abdominal pressure: such as severe coughing, vomiting, intra-abdominal tumor growth, pregnancy will promote the occurrence of parastomal herniae, such as female obesity, multiple births or weak abdominal wall, Or there is increased intra-abdominal pressure caused by chronic obstructive pulmonary disease, and it may be due to factors such as postoperative malnutrition, advanced age, and local infection of the wound that will lead to weak and defective abdominal wall tissue next to the stoma, and other tissues in the abdominal cavity. For example, the intestine protrudes from the weak point, causing the abdominal wall next to the stoma to bulge.
The complications of parastomal hernia are as high as 30%-50%, especially in the elderly.
What are the symptoms of a parastomal hernia?
The parastomal hernia will become more and more bulging, and it will bring many inconveniences to life:
1. Inconvenient mobility:
The abdominal wall next to the stoma is bulging, which increases after standing, walking, and exerting force, and can be retracted and disappeared after lying down in the early stage. There are no symptoms in the early stage, but as the course of the disease prolongs, the parastomal hernia will gradually become larger.
2. Increase the difficulty of care:
It will cause the chassis of the ostomy bag to be stuck and leak, which will increase the difficulty of ostomy care.
3. Bad effects on health:
In severe cases, it will cause intestinal adhesion, abdominal pain, abdominal distension, and even intestinal incarceration or narrow necrosis.
What causes a parastomal hernia?
The stoma operation itself will cause a partial abdominal wall defect, and the size of the stoma hole is difficult to achieve just right. If the hole is too small, the stoma will be narrow and it will be difficult to defecate. If it is too large, a small gap will be formed next to the stoma.
The peristalsis of the intestinal tube is continuous, and it has a strong impact on the tissues around the stoma. Over time, the original space next to the stoma will become larger, resulting in paraphernalia.
In addition, factors such as severe cough, difficulty in defecation, and increased intra-abdominal pressure such as ascites can also lead to a parastomal hernia. In addition, malnutrition, postoperative wound infection at the stoma site, and improper operation of operation can also increase the incidence of parastomal hernia.
Especially the elderly, and the significant weight loss after surgery will relax the abdominal wall, thin the fat, and increase the incidence of parastomal hernia.