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July 27, 2009 Exploratory Laparotomy and Transverse Loop Colostomy 1.
July 27, 2009 Exploratory Laparotomy and Transverse Loop Colostomy 1.
1. EXPLORATORY LAPAROTOMY
PRE-OPERATIVE CARE
• Do not take aspirin or other anti-inflammatory drugs for one week before
surgery, unless told otherwise by your doctor. You may also need to stop
taking blood-thinning medications. Examples include clopidogrel (Plavix),
warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
POST-0PERATIVE CARE
• The patient will remain in the postoperative recovery room for several
hours where his or her recovery can be closely monitored.
• Monitor for signs and symptoms of:
This type of colostomy allows the feces to exit from the colon before
they reach the descending colon. When conditions such as those listed are
present in the lower bowel, it may be necessary to give the affected portion of
the bowel a rest. A transverse colostomy may be created for a period of time
to prevent feces from passing through the area of the colon that is inflamed,
infected, diseased or newly operated on, thus allowing healing to occur.
• Preparation for colon surgery begins a few days prior to the procedure
unless the surgery is being done on an emergency basis, such as for an
injury or intestinal bleeding. Most patients have undergone a
colonoscopy, sigmoidoscopy, or barium enema to diagnose the
disease. These tests generally are not repeated. Prior to the operation,
blood tests, a chest x-ray, an EKG, and an abdominal CT scan may be
ordered.
• The colon contains bacteria and waste products that can cause
infection if they leak into the abdomen during surgery and precautions are
taken to reduce this risk. Oral antibiotics are started several days before
the operation is scheduled and the colon must be as empty as possible.
• On the day after surgery, most patients get out of bed and walk
around. It is important to get up as soon as possible to stimulate bowel
function and help blood circulation return to normal.
• The most difficult part of the postoperative period is adjusting to the
colostomy. The opening is on the right or left side, depending on where
the removed section of colon was located. The stoma is red and,
immediately after surgery, there may be a bandage covering it. When
stool starts to come out through the stoma, the colon is healing.
• Stools from a stoma are generally softer and looser. The opening must
always be kept covered by a special pouch designed to hold the stool.
The pouch is changed after a bowel movement.
• An enterostomal therapist teaches the patient how to care for the
colostomy and provide assistance with any problems that occur with an
ostomy. It is vital that patients and/or their family members learn
proper care of the colostomy before the patient is discharged from the
hospital.
• Hospitalization ranges from 3 to 10 days, and normal activity can
usually be resumed within 1 to 3 weeks. It takes longer for the body to
heal completely and strenuous exertion and heavy lifting must be
avoided for 4 to 6 weeks.
• Having a colostomy puts few restrictions on the patient, once initial
healing has occurred. There are usually no limitations on diet, sports,
activities, work, or travel. Sports that involve rough and frequent body
contact and jobs involving very heavy lifting are not advised.
• Postoperative Complications
bleeding,
infection,
leakage around the stoma, and
injury to surrounding organs during the procedure.
If there is drainage, bleeding, or swelling at the incision site, pain
that is not relieved by medication and comfort measures, a sudden
fever, or rectal bleeding, the surgeon must be contacted immediately.
If the stoma is painful to the touch, draining blood, or swollen, infection
or other complications may be indicated.
4. DEBRIDEMENT
An open wound or ulcer can not be properly evaluated until the dead
tissue or foreign matter is removed. Wounds that contain necrotic and
ischemic (low oxygen content) tissue take longer to close and heal. This is
because necrotic tissue provides an ideal growth medium for bacteria,
especially for Bacteroides spp. and Clostridium perfringens that causes the
gas gangrene so feared in military medical practice. Though a wound may not
necessarily be infected, the bacteria can cause inflammation and strain the
body's ability to fight infection. Debridement is also used to treat pockets of
pus called abscesses. Abscesses can develop into a general infection that may
invade the bloodstream (sepsis) and lead to amputation and even death.