For malignant intestinal neoplasms, oncologists at the Yusupov Hospital often perform an ileostomy. The oncology clinic has medical staff who teach patients how to manage their stoma. People get better at living with an ileostomy over time. Reviews about the operation indicate that patients learn to cope with the problem and lead an active lifestyle.
Ileostomy - what is it? An ileostomy is an artificial outlet from the final portion of the small intestine. Through it, intestinal gases and undigested food debris are removed. During this operation, oncologists perform a partial or complete resection of the large intestine and the final section of the small intestine is sutured to the anterior abdominal wall. The presence of an ileostomy is an altered state of body functioning. This operation is performed to treat the underlying disease or relieve its symptoms.
The Yusupov Hospital employs professors and doctors of the highest category. Oncologists use various methods of making an opening in the small intestine: they perform an ileostomy according to Mikulicz, and apply an ileostomy according to Thornebull. Nurses provide patient care during an ileostomy. Psychologists help people adapt to new living conditions.
Indications for ileostomy
Oncologists at the Yusupov Hospital take an individual approach to the selection of indications for ileostomy. In case of injury or damage to the rectum, a temporary ileostomy is formed. For patients with colon cancer, the affected part of the intestine is removed and an ileostomy is performed. An ileostomy is formed in case of certain inflammatory diseases or colon polyposis after complete or partial resection of the colon.
An ileostomy is applied if the following indications exist:
- intestinal obstruction;
- volvulus;
- adhesive process of the abdominal cavity.
In reconstructive surgery of the rectum, a temporary ileostomy is also formed.
Reconstructive surgeries in patients with an ostomy
Modern capabilities of colorectal surgery make it possible increasingly to positively resolve the issue of performing reconstructive operations for patients in whom the scope of surgical intervention previously did not imply the technical possibility of restoring intestinal continuity. The qualifications of EMC coloproctologist surgeons, experience in performing such operations and the technical equipment of operating rooms allow them to perform an operation of any degree of complexity, the only condition being the possibility of reconstructive surgery, which is assessed individually for each ostomy patient.
Ileostomy care
The oncology clinic's medical staff cares for the ileostomy and teaches the patient how to cope with the problem after discharge from the hospital. The goal of ileostomy care is to safely remove all bowel secretions and protect the skin of the anterior abdominal wall.
The stoma is pink or red in color and elliptical or round in shape. It protrudes about 3-4 cm above the surface of the skin. Immediately after surgery, slight swelling of the stoma may develop. Over the course of several weeks, the hole shrinks and takes on its final size. Normally, the stoma produces a small amount of white mucus or some blood. Because the ileostomy is sensitive to pain and injury, it must be handled with great care.
Since most of the water is normally absorbed in the large intestine, the discharge from the ileostomy will be more watery at first. Later they become less liquid. Even with full adherence to a normal diet, the discharge remains mushy.
During the first time after the formation of an ileostomy, the patient feels discomfort, weakness and pain in the area of the surgical wound. During the first few days, the intestines do not function, which allows the wound to heal better. After the intestines have resumed functioning, the medical staff of the Yusupov Hospital teaches the patient how to independently care for the ileostomy.
At the moment, there is a large selection of colostomy bags that are attached to the ileostomy and secured to the anterior abdominal wall using a variety of fasteners. This ensures maximum comfort and safety. Close relatives of the patient are involved in the training process. They will be able to help the patient with autonomous treatment in the future. After discharge from the oncology clinic, a specially trained nurse will teach the patient how to apply a hernia bandage with an ileostomy, monitor the correct use of the ileostomy, and answer all questions that arise.
In what cases are reconstructive surgeries to close a colostomy possible?
As already mentioned, colostomies can be temporary or permanent.
A temporary colostomy is performed for the period of treatment of the underlying parts of the colon. Permanent - when these sections are removed due to impossible or ineffective further treatment.
Closing a colostomy is called a colostomy.
Temporary colostomies are closed by removing the sutures on the skin and dividing the engrafted areas, which usually form within a month after the colostomy. With a double-barreled type of colostomy, the usual suturing of the intestinal walls is carried out; a single-barrel type requires more complex procedures to unite the intestinal walls using sutures or special surgical staples that can be reabsorbed in the future. The edges of the intestine are connected using end-to-end or side-to-side methods. Immediately after the anastomosis of the edges, before closing the abdominal wall and skin, the tightness of the connection must be checked using contrast.
Changing a colostomy bag with a formed ileostomy
If there is an ileostomy, the colostomy bag must be replaced. Most people do this procedure in the bathroom. It can be done with warm water using a regular bowl, using a mirror. First you should prepare everything you need:
- plastic bag and paper for cleaning;
- wet wipes that do not contain alcohol solutions for treating the ileostomy and the skin around it;
- scissors for opening the protective hole;
- a protector (a fragment that protects the skin), which should first be cut and brought to the shape and size of the ileostomy;
- a special colostomy bag corresponding to an ileostomy;
- colostomy bag cover;
- sealing ointment;
- skin protection material;
- adhesive bandages made of microporous material and odor neutralizer.
The skin protector is prepared depending on the shape and size of the ileostomy. Then the previous protector is removed from top to bottom, after which it is placed in a special plastic bag. In order not to clog the sewer, it is not recommended to throw used colostomy bags into the toilet.
The skin around the ileostomy should be washed thoroughly with soap, water and a soft cloth and dried gently. Before installing a new protector, you need to treat the leather with a special protective agent. It is recommended to add a few drops of odor neutralizer to the colostomy bag before installation.
First, remove the paper from the back of the protector and place it on a clean and dry area of skin. Then you should make sure, using a slight tension, that the colostomy bag is attached properly, and the lid at the bottom of the bag closes tightly. For convenient fastening of the colostomy bag, a special belt is used.
The contents of the colostomy bag are removed directly into the toilet. After emptying, the bag is rinsed with water, a few drops of neutralizer are applied and closed again. If you experience a burning sensation or itching around the ileostomy, remove the protective sheath, rinse the skin thoroughly, dry it well and lubricate it with a protective cream.
Nutrition in late stages of illness
In the last stages of a malignant process with metastases, many patients experience such unpleasant symptoms as fatigue and weakness, nausea and vomiting, aversion to food, changes in taste and olfactory preferences, bowel disorders such as constipation or diarrhea.
All these clinical manifestations provoke such a complication as inevitable weight loss. It is possible to restore a patient's appetite and improve his quality of life at a late stage of cancer with the help of foods that have an increased calorie content. These include:
- nuts and dried fruits with a pleasant aroma;
- strawberries, blackberries and other fragrant berries and fruits that stimulate the appetite;
- freshly cooked lamb, rabbit or poultry with herbs.
Diet for ileostomy
The presence of an ileostomy does not limit the patient’s diet in any way. For two weeks after surgery, low-fiber vegetables and fruits are introduced into the diet. The patient is recommended to drink 2-2.5 liters of water per day in winter; in summer, the volume of fluid consumed is increased.
It is necessary to avoid foods that cause increased gas formation. New foods must be introduced into the diet in small quantities and gradually. A person with an ileostomy forms their diet independently, taking into account individual food tolerance. Nutrition during ileostomy should be balanced. A weekly menu for a diabetic patient with an ileostomy can be compiled by receiving a free consultation from a nutritionist at the Yusupov Hospital.
The postoperative period after closure of the ileostomy proceeds smoothly in most cases. The diet after closure of the ileostomy is aimed at intestinal patency. Doctors prescribe special medications, hydromassage of the non-functioning part of the intestine, and recommend following a diet. It is not recommended to eat vegetables and fruits for several months. Boiled vegetables and fruits can be introduced into the diet no earlier than 6 months after surgery.
Colostomy - what is it and how to live with it?
For oncological diseases, congenital anomalies, and some other diseases, a person is given a colostomy. At its core, this is an additional hole in the abdominal cavity through which feces exit.
A colostomy is formed from a part of the intestine; doctors create an “emergency exit”, bypassing one or another part of the digestive organ. Bypassing the hole formed by doctors, the processed food ends up in a special bag called a colostomy bag.
Much depends on the underlying disease that caused the problem. Often a stoma is installed temporarily. Less often - forever.
At the initial stage, a colostomy causes serious discomfort to a person, both physically and psychologically. People withdraw into themselves, limit communication, behave inappropriately, showing increased irritability.
If the cause of the stoma is not oncology, then it can be closed after a certain period of time. But the decision to carry out such manipulations is made by a doctor.
But the presence of a colostomy is not a contraindication to communication, and also:
- Visiting the gym, doing certain exercises, visiting the pool.
- Sexual life, since it does not affect human sexual activity.
- Visiting public places, with a colostomy you can go to the theater, cinema, cafe.
Much depends on the psychological state of the person who has undergone such an operation. Often such patients need the help of a psychologist who will help restore the usual rhythm of life and cope with the problem.
Over time, patients are allowed to swim in ponds and eat a standard diet of foods.
Complications of ileostomy
The skin around the ileostomy should be intact, without redness, cracks, wounds or peeling. Skin irritation can occur for the following reasons:
- too large an exposed area of the protector, which leaves the skin surrounding the ileostomy unprotected;
- an extremely small open area of the protector, which prevents good adhesion of the skin and the colostomy bag and contributes to the accumulation of secretions under the protector;
- fecal leakage;
- allergic reaction to a plastic bag or other elements of a colostomy bag;
- fungal infection of the skin around the ileostomy;
- folliculitis (infectious inflammation of hair follicles)
Constipation with ileostomy rarely develops. If the patient does not pass bowel movements from the ileostomy for several days, intestinal obstruction should be considered. In this case, the patient is advised by a doctor. An enema for ileostomy is given if intestinal function is not restored within 4-5 hours. After rinsing the ileostomy, it begins to function again.
Patients with an ileostomy may develop diarrhea. The cause of diarrhea is inflammation of the digestive tract, taking certain medications, anxiety and stress. How to slow down intestinal motility during ileostomy? The patient is not recommended to self-administer antidiarrheal medications. It is necessary to limit food intake, drink tea and water. If the diarrhea does not stop within 24 hours, you should call your doctor. He will tell you how to treat diarrhea with an ileostomy.
By calling the Yusupov Hospital, you can get specialist advice. Oncologists at the clinic use various methods for creating ileostomies. Medical staff provide care and help patients learn to live with an intestinal stoma.
Author
Alexey Andreevich Moiseev
Head of the Oncology Department, oncologist, chemotherapist, Ph.D.
Features of the diet for adults, children, pregnant and lactating women, the elderly
Rectal cancer is a serious pathology that occurs in patients regardless of their gender and age. Once a diagnosis is made, it is important to begin treatment measures as quickly as possible to stop the growth of the tumor and prevent its metastasis. At the same time, diet plays an important role in the fight against this cancer.
But there are no fundamental differences in nutrition in individual groups of patients. The same principles of a therapeutic diet are recommended for both children and adults, including six meals a day, adherence to the list of permitted and prohibited foods, etc.
Bibliography
- ICD-10 (International Classification of Diseases)
- Yusupov Hospital
- Cherenkov V. G. Clinical oncology. — 3rd ed. - M.: Medical book, 2010. - 434 p. — ISBN 978-5-91894-002-0.
- Shirokorad V.I., Makhson A.N., Yadykov O.A. The state of oncourological care in Moscow // Oncourology. - 2013. - No. 4. - P. 10-13.
- Volosyanko M.I. Traditional and natural methods of preventing and treating cancer, Aquarium, 1994
- John Niederhuber, James Armitage, James Doroshow, Michael Kastan, Joel Tepper Abeloff's Clinical Oncology - 5th Edition, eMEDICAL BOOKS, 2013
Types of colostomy bags
Colostomy bags come in one- and two-component types. Two-component ones are equipped with ostomy bags and a self-adhesive plate, connected by a special flange. But such colostomy bags are inconvenient because they can cause skin irritation. Therefore, when using them, it is allowed to replace the plate every 2-4 days, and the bag - daily.
If there is a feeling of itching and discomfort, it is recommended to immediately peel off the plate. An undoubted advantage is that the colostomy bag is equipped with a special filter that eliminates gases and odors.
Unlike a two-component one, a one-component colostomy bag must be changed every 7-8 hours. Two-component ones involve replacing only the bag, and the plate is changed only once every 3-4 days.
The drainage bag must be emptied when it is 1/3 full; to do this, bend over the toilet a little and open the drainage hole, after which the feces bag must be washed and dried. Before reusing the bag, check the drainage hole to ensure it is closed.
What to do if the stoma is not functioning
If constipation occurs, the colostomy is clogged and does not work, the following actions may help:
- Take a shower. Warm water helps relax the abdominal muscles.
- Abdominal massage.
- Take a knee-elbow position, pull your legs towards your stomach; these poses will relieve muscle tension and activate the work of the ostomy intestine.
- Check for swelling of the stoma papilla. The opening of the colostomy bag must be suitable in size and not cause swelling of the stoma.
- Regulate your diet.
- Increase your physical activity
Self-administration of laxatives is contraindicated, since constipation may be caused by intestinal disease, which requires consultation with a doctor. You also cannot perform an ostomy irrigation (enema) yourself; the procedure must be carried out in a medical facility under the supervision of a doctor.
Dish recipes
The diet after intestinal surgery involves certain foods and the correct way to prepare them so as not to harm the still vulnerable intestines.
Diet zucchini stuffed with cheese is prepared in the following way:
- Cut one medium zucchini, one onion, two cloves of garlic into circles.
- A baking sheet is greased with vegetable oil, vegetables, except garlic, are laid out on it.
- Garlic and 100 g of cheese are grated on a fine grater, 2 eggs are driven in, 250 g are added. sour cream, mix everything - you get a sauce;
- Place 1 tbsp on top of each zucchini circle. l. prepared sauce.
- The dish is cooked in the oven at 180 degrees for half an hour.
Chicken soufflé is the most recommended dish for intestinal restoration; it will require:
- One slice of white bread is soaked in 200 ml of cream.
- 800 g of chicken fillet is cut into medium pieces, then crushed in a blender.
- Beat 2 eggs intensively with a mixer.
- 100 g of potatoes need to be grated on a coarse grater.
- All ingredients are mixed and placed in small molds.
- Steam the dish for 45 minutes.
- When serving, you can serve with fresh herbs and sour cream.
Pear baked in the oven:
- Hard pear fruits from 3 to 5 pieces need to be washed and divided in half, while removing the core.
- If desired, sprinkle the fruit pulp with 3 tsp. sugar, 1 tsp. cinnamon and vanilla.
- If your diet allows, you can add 15 g of butter.
- Wrap the fruit with all the additives in foil.
- The dish is baked in the oven at 180 degrees or in a multicooker on the baking program for half an hour.
Special recipes play a medicinal role and will help diversify the taste of a dietary dish.
A restorative diet prescribed after surgery plays an important role - it prevents relapse of the disease. A proper diet will help to avoid postoperative complications on the intestines and will allow you to return to your normal life routine as soon as possible.
Article design: Vladimir the Great
