An acute obstruction of the bowel may necessitate a temporary drainage through the abdominal wall. This will be the case when circumstances such as environment, lack of experience, assistance, or equipment preclude a laparotomy; or even when a laparotomy is done and it is found impossible at the time to remove the cause.
Enterostomy is therefore a life-saving operation which every practitioner must know how to perform. The operation proposes opening the abdomen, anchoring a loop of intestine in the abdominal wound and opening this loop to secure drainage. No special instruments are required; local anesthesia may suffice.
Incision begins by dividing the skin and fat along a line two fingers’ breadth from the anterior superior iliac spine, parallel with the fibers of the external oblique—an incision about three inches long, whose central point corresponds to the anterior superior iliac spine. Catch up the two or three bleeding points. This first incision exposes the external oblique and the second divides that muscle in the same line.
The third incision divides the internal oblique and transversalis, finally exposing the peritoneum which is carefully divided to reach the distended bowel. A reddish fluid escapes as soon as the peritoneum is opened; see each lip with forceps and enlarge the opening but not to the full extent of the skin wound.
A loop of bowel is anchored by suturing it to the abdominal wall in a series of U-shaped stitches, ensuring the protruding segment does not fold or wrinkle. The superficial wound is repaired using interrupted sutures in two layers—one reuniting the muscles; the other, the skin.
The bowel is then opened with a bistoury for about an inch to allow gas escape and dressing changes every half-hour initially, reducing frequency as healing progresses. When the bowel empties itself, locate the site of obstruction and determine its nature by testing enema or injection discharge at the wound.
For permanent artificial anus due to rectal cancer, the sigmoid is drawn out and anchored separately in a large opening over the left iliac fossa. The operation may be done in two stages: first, drawing out the sigmoid; second, resecting it with a thermo-cautery after adhesions form.
<Callout type="important" title="Critical Step">Ensure that the bowel is anchored securely to prevent leakage and infection.</Callout>
When the bowel empties itself, locate the site of obstruction and determine its nature by testing enema or injection discharge at the wound. A month later when the patient has regained strength, if the bowel hasn't normalized, send him to a specialist.
For permanent artificial anus due to rectal cancer, the sigmoid is drawn out and anchored separately in a large opening over the left iliac fossa. The operation may be done in two stages: first, drawing out the sigmoid; second, resecting it with a thermo-cautery after adhesions form.
<Callout type="warning" title="Danger">Do not persist in searching for an obstruction or attempting to relieve it if unsuccessful initially.</Callout>
Key Takeaways
- Enterostomy is a critical procedure for bowel obstructions when laparotomy cannot be performed.
- Local anesthesia and basic instruments suffice for temporary enterostomies.
- Permanent artificial anuses are palliative measures for rectal cancer, providing relief from pain and discomfort.
Practical Tips
- Practice making incisions on a model to improve precision and reduce risk of infection.
- Ensure proper anchoring of the bowel to prevent leakage and promote healing.
Warnings & Risks
- Do not persist in searching for an obstruction or attempting relief if unsuccessful initially.
- Permanent artificial anus procedures should be performed by experienced practitioners due to their complexity.
Modern Application
While modern medicine has advanced significantly, the principles of emergency surgery remain crucial. Techniques like enterostomy are still relevant today, especially in remote areas where immediate medical care is unavailable. Understanding these historical methods can provide a life-saving fallback when conventional treatments aren't an option.
Frequently Asked Questions
Q: What instruments are needed for performing an enterostomy?
No special instruments are required; local anesthesia and basic surgical tools such as needles, silk thread (Nos. o or r), forceps, and a bistoury suffice.
Q: How is the bowel anchored during an emergency enterostomy procedure?
The bowel is anchored by suturing it to the abdominal wall in a series of U-shaped stitches, ensuring that the protruding segment does not fold or wrinkle.
Q: What are the steps for performing a permanent artificial anus due to rectal cancer?
A large opening over the left iliac fossa is made and the sigmoid colon is drawn out and anchored separately. The procedure may be done in two stages: first, drawing out the sigmoid; second, resecting it with a thermo-cautery after adhesions form.