ENTEROSTOMYYa (Greek enteron a gut + stoma of companies, an opening, pass) — surgery of imposing of outside fistula on a small bowel.
The indication for E. in upper parts of a small bowel such states are, at to-rykh the patient needs to enter nutritious mixes (e.g., at impassability of a peloric part of a stomach because of an inoperable tumor, insolvency of a stump of a duodenum, corrosive burns of a gullet and stomach, heavy pancreatitis). AA. average departments of a small bowel make at treatment of paresis of intestines because of its atony, at dynamic intestinal impassability, peritonitis. AA. in lower parts of a small bowel it is shown for evacuation of its contents after a kolzhpgomiya (see) concerning nonspecific ulcer colitis, a disease Krone (see Krone a disease) and diffusion a polypose of a large intestine.
AA. can be temporary and constant depending on the basic patol. process, apropos to-rogo it it is made. Temporary E. it is shown in cases when after radical intestines operations recovery of a passage of its contents is possible on went. - kish. to a path. Enterostoma is imposed for unloading below the imposed interintestinal anastomosis after an ileoproctostomy, and also for artificial feeding of patients at development of intra belly and intra pelvic complications after radical a large intestine operations, napr, at development of intestinal impassability, insufficiency of seams of an intra belly intestinal anastomosis with development of peritonitis (see), a necrosis of the reduced gut with suppuration in a cavity of a small pelvis. Constant E. make after a colectomy with a belly and proctal rectectomy. Depending on with what department of a small bowel create to enterosty, distinguish eyunosty when fistula is imposed at the level of a jejunum, and ileosty — burrowing of an ileal gut.
Distinguish pristenochny (suspended), single-barreled and double-barreled E. Pristenochnuyu (suspended) E. carry out in modifications Vit-aiming — Ayzelsberg, Richardson — Yudina. Enterostomy across Vittsel — to Ayzelsberg (fig. 1): after a laparotomy (see) in a wound remove a loop of a small bowel, in a wall a cut do a section to 0,5 cm in the diameter and enter into it in the distal direction a rubber or plastic tube of the same diameter for administration of nutritious drugs, pull together with a purse-string seam a wall of a gut around a tube then separate gray and serous seams over a tube create the channel of a wall of a gut, as at a gastrostomy (see) by Vittsel's method. A. Littre suggested to fix several seams a gut to a parietal peritoneum, the wound of a front abdominal wall is taken in to the removed tube. After removal of the tube of an enterostom removed outside within several days it is closed independently. A lack of the specified methods of formation of an entero-ostomy is considerable narrowing of a gleam of a small bowel owing to creation of the channel for a rubber tube gray and serous seams.
Pristenochny E. in Richardson's modifications — Yudina carry out in the following sequence: after a laparotomy and extraction of a loop of a small bowel on its wall against the place of an attachment of a mesentery put a purse-string stitch, in the center to-rogo puncture an opening. Through this opening on the course of a gut enter a thin rubber tube
of Fig. 1. The diagrammatic representation of the main stages of enterostomy across Vittsel — to Ayzelsberg: and — the loop of a jejunum (I) is removed in a section on a front abdominal wall; the rubber tube with annular pication (2) over which gray and serous seams create the channel is shipped in a gleam of a gut; — the type of an entero-ostomy after setting of gray and serous seams, over a tube is created the channel from a wall of a gut (3) s
of Fig. 2. The diagrammatic representation of a pristenochny enterostoma according to Richardson — to Yudin: the rubber tube (1) with the rubber cuff (2) which is put on it is entered into a gleam of a jejunum (3) and fixed by a purse-string seam; the dotted line designated the part of a tube which is in a gleam of a gut.
with a diameter up to 0,5 cm, to-ruyu fix a catgut to edge of a wound of an intestinal wall and tighten a purse-string seam around a tube (fig. 2). Over a purse-string seam in addition put four gray and serous stitches on a wall of a gut. The free end of a tube is spent through a puncture in a front abdominal wall in its inferiolateral departments. The tube removed outside is hemmed to skin for the rubber cuff which is put on it, tightening to an abdominal wall thus a loop of a small bowel, edges «is suspended» to a cuff for the entered rubber tube. At the initiative of S. S. Yudin suspended E. it was widely applied at peritonitis at wounded in a stomach. However at suspended E. the loop of a small bowel sometimes departed from a front abdominal wall that inevitably caused peritonitis therefore the gut began to be fixed to a front abdominal wall the noose sutures put around a tube.
At single-barreled E. in modification of Mayo-Robsona (fig. 3, a) the loop of a small bowel is brought to skin, between bringing and taking away her knees impose an anastomosis a side sideways (see Enteroenteroanastomoz), the bringing knee is taken in, and enter a rubber tube for food of the patient into taking away. In connection with complexity of this technique it is applied seldom. At single-barreled E. in Maydl's modification after a laparotomy the small bowel is crossed in 30 cm from Treyt-ts's team. The proximal end of a gut anastomose the end sideways about tone -
Fig. 3. The diagrammatic representation single-barreled enterosty across Mayo — to Robson (a) and across Maydl: and — between the bringing and taking away loops of the jejunum brought to skin it is imposed enteroenteroanastomoz a side sideways (J), the bringing loop is tied up by a ligature (2); — the jejunum is crossed, the taking-away end (z) is brought to skin, bringing the end sideways (4) by 20 — 30 cm below the place of crossing of a jejunum is connected by an anastomosis.
which a gut is 20 cm lower than the place of crossing. The distal end is spent in the slanting direction, taken through a separate section in a front abdominal wall and fixed to skin (fig. 3, b).
In scientific research institute of a proctology M3 of RSFSR the following technique of formation of a trailer single-barreled ileostoma is offered: after a median laparotomy in the right ileal area at edge of a direct muscle of a stomach on the right and from below from a navel tsir-kulyarno excise the site of skin together with hypodermic cellulose with a diameter of 2 — 2,5 cm. Then under control of a finger from an abdominal cavity crosswisely cut an aponeurosis of an outside oblique muscle of a stomach then in the stupid way stratify fibers of internal slanting and cross muscles, prebelly cellulose with a section of a peritoneum. The small bowel after its crossing in 2 — 4 cm from the place of falling into a caecum and partial mobilization of a mesentery is removed in a section of a front abdominal wall. The peritoneum is hemmed to a wall of a small bowel, and its edge after a partial reversing of a mucous membrane is hemmed to skin of a front abdominal wall. The created enterostoma has an appearance of a column or a proboscis 6 — 7 cm long that considerably facilitates care of it.
According to indications performance single-barreled E is possible. with preservation of the ileocecal valve, at the same time hem the site of its wall found from a dome of a caecum with the ileocecal valve to skin that the nek-swarm of regulation of receipt of contents of a gut in a kalopriyemnik promotes. Closing single-barreled E. represents the reconstructive intestines operation directed to recovery of a passage of its contents.
Double-barreled E. with removal of both ends of an ileal gut (ileostom) it is carried out in the following sequence: in a slanting section of a front abdominal wall in the right ileal area 10 — 12 cm long remove a loop of a small bowel and longwise cut a mesentery. The bringing and taking away pieces of the removed intestinal loop have in corners of a wound of an abdominal wall at distance from each other, layer-by-layer take in an abdominal wall, without squeezing the removed loop of a gut, both pieces of a gut fix to skin, cross a loop. For formation of proboscises the mucous membrane of a gut is twisted and hemmed to skin.
AA. make under the general anesthesia, special preparation, except standard for hollow abdominal organs operations, it is not required (see. Preoperative period).
Complications E. hits of intestinal contents on skin around an ostomy result that leads to development of dermatitis, prevention to-rogo is careful care of an ostomy, processing of skin around an ostomy Jlaccapa paste, zinc oxide ointment, use of various plasters. Heavier complications are possible: a cicatricial stenosis of an enterostoma, its loss or retraction, regional fistulas, paraen-terostomichesky hernias, development of peritonitis at an otkhozhdeniya of a loop of a gut from a front abdominal wall. Prevention of these complications is careful implementation of rules of the surgical technology of formation of an enterostoma, careful imposing of a skin and mucous seam. Treatment of these complications operational. Heavy complication E. the infringement of a loop of a small bowel in a window between its mesentery and a parietal peritoneum leading to emergence of impassability of intestines is. In these cases an urgent operative measure and reconstruction of an enterostoma is shown.
See also Intestines, operations. Bibliography: Fedorov V. D. and
Dultsev Yu. V. Proctology, M., 1984; Fedorov V. D. and Levitan M. of X. Inflammatory diseases of a large intestine, Tashkent, 1982; Devlin H. B. Die Stomatherapie, Coloprocto-logy, v. 4, p. 250, 1982; Me Leod R. S. a. Fazio V. Quality of life with the continent ileostomy, Wld J. Surg., v. 8, p. 90, 1984; Mulholland M. W. a. Delaney J. P. Proximal diverting jejunostomy for compromised small bowel, Surgery, v. 93, p. 443, 1983;
Oran-g i about G. a. o. A new type of continent ileostomy, Dis. Colon Rect., v. 27, p. 238, 1984; Principles of ostomy care, ed.
by D. Broadwell a. B. Jackson, St Louis — L.,
1982. G. A. Pokrovsky.