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OPERATION FOR LOOP ILEOSTOMY


By • Дек 18th, 2010 • Category: For surgery

SURGICAL TREATMENT OF NONSPECIFIC ULCERATIVE COLITIS

Operative treatment of this condition is indicated in patients with severe foims of continuous or relapsing ul-cerative colitis which does not yield to conservative treatment, and also in all cases with acute toxic dilatation of the colon.

OPERATION FOR LOOP ILEOSTOMY

This operation is employed in those cases when the surgeon hopes to achieve cure or improvement by discon­tinuing the passage of intestinal contents through the colon affected with an ulcerative process.

With the patient lying on his back and under ether-oxygen anesthesia or local anesthesia according to A. V. Vishnevsky, an oblique incision is made in the right iliac region to open the abdominal cavity as in appendec­tomy. The aponeurosis, abdominal wall muscles, and pe­ritoneum are dissected along the incision line and the terminal loop of the ileum is brought out (Fig. 187,1) and divided between clamps at a distance of 10 cm from the Bauhin’s valve. The ileac mesentery is ligated on both sides at a distance of 7 cm from the division line leaving a fringe to continue the blood supply to the bo­wel. The distal and proximal ileac segments should be disposed in the opposite corners of the operative wound (Fig. 187,2). The free edge of mesentery between the bo­wel segments is fixed by 3 or 4 fine silk sutures to the parietal peritoneum in the incision area (Fig. 187,3). This manoever will prevent strangulation of the small gut between the mesenteric edge and parietal peritoneum.

То form the ileostomy, the intestinal stump margin is sutured with silk to the skin edge along the incision line. In all 4 such sutures are applied equidistantly around the circumference of each stump (Fig. 187,4). In tightening these sutures the stump is everted thus forming an ileostomy with a double wall (Fig. 187,4); its height is 3—3.5 cm.

Ileostomy in ulcerative colitis

Fig. 187. Ileostomy in ulcerative colitis:

1. The terminal ileac loop has been passed to the wound.

2. The proximal and distal segments of the ileum are disposed at the wound angles.

3. The bowal segments have been placed at the wound angles and the free mesenteric edge is sutured to the parietal peritoneum.



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