RU2803013C1 - Method of treatment of complications caused by colostomy inflammation - Google Patents

Abstract

FIELD: medicine; abdominal surgery; coloproctology.

SUBSTANCE: festering suture material or tube to fix the stoma are removed. The wound is dried with napkins. A mixture of Celoform and Streptocid powders in equal proportions is sprayed onto the affected areas around the stoma. A colostomy bag is applied on top, dressings are carried out once every 3 days until the wound heals.

EFFECT: method allows to increase the efficiency of conservative treatment, promotes faster wound cleansing and formation of soft scars after healing, reduces the healing period, reduces the frequency of local adverse reactions due to the combined use of a mixture of Celoform and Streptocide powders.

1 cl, 4 dwg, 2 ex

Description

The invention relates to medicine, namely to surgery, and concerns a medicinal method for treating complications caused by inflammation of a colostomy.

In developed countries, the number of people undergoing intestinal stoma operations due to various diseases is constantly growing. Despite the high level of surgical rehabilitation, the number of ostomy patients in Russia is about 150,000 people. Ostomy patients need a comprehensive medical and social rehabilitation program. The general principles of rehabilitation are individuality and consistency. Complications after stoma surgery are a significant problem for many patients. Suppuration of the parastomal wound contributes to the occurrence of subsequent complications, such as retraction of the colostomy, necrosis of the intestinal wall, paracolostomy abscesses, eventration of other parts of the intestine, interintestinal abscesses, and deformation of the colorectal anastomosis. The developed methods and devices are mainly aimed at treating complications of colostomy, and not at their prevention. All this indicates the need to create and improve methods for the prevention and treatment of colostomy complications. Studies conducted in different countries show that up to 71% of patients with ileostomy and 43% with colostomy have complications.

There is a known method for healing and preventing inflammatory complications after removal of a colostomy, washing wounds with a pulsating stream of liquid (antiseptic) (Kostyuchenok B.M. Karlov V.A. Treatment of purulent wounds by prolonged rinsing and drainage. // Modern methods of active surgical treatment of purulent wounds and acute purulent surgical diseases, Yaroslavl, 1980, pp. 29-32).

The disadvantages of this method are that the use of a jet with a low output pressure does not ensure high-quality cleaning of the wound from purulent-necrotic tissue; mechanical cleaning is performed only in the superficial layers of the wound, while the bulk of microbes, including anaerobic infection, are located deep in the infiltrate; there is a real danger of bacterial contamination of the operating cavity due to the formation of a large amount of splashes, since the flow of a stream of liquid under low pressure to achieve the desired effect according to the laws of physics requires more of it, and also the disadvantages of old traditional methods of treatment, as well as most new ones, are insufficient effectiveness in cleansing the wound from purulent-necrotic tissue and eliminating the source of infection, especially if there is a chronic purulent process (suppuration of the suture material). In addition, the use of many modern tools is associated with high material costs and the complexity of maintenance (Datsenko B.M. Belov S.G. Timm T.I. Purulent wound. Kiev: Health, 1985, p. 139).

The objective of the invention is to create a method for treating complications caused by inflammation of a colostomy, providing a technical result consisting in improving the quality of conservative treatment, reducing the healing time and reducing the frequency of adverse local reactions.

This technical result is achieved by the fact that the method includes washing the wound with an antiseptic solution.

A special feature is that the festering suture material or tube for fixing the stoma is removed, the wound is dried with napkins, a mixture of Celoform and Streptocide powders in equal proportions is sprayed onto the affected areas around the stoma, and a colostomy bag is placed on top, dressings are carried out once every 3 days until the wound heals.

The invention is illustrated by a detailed description, clinical examples and illustrations, which show:

Fig. 1. Second week after removal of the colostomy.

Fig. 2. 4 days after removing the ligature and applying a mixture of Celoform and Streptocide powders.

Fig. 3: Two weeks after removing the ligature and applying a mixture of powders. “Celoform” and “Streptocida”

Fig. 4: Complete healing after 23 days.

The method is carried out as follows.

After removing the festering suture material or tube to fix the stoma, the affected areas are washed with an antiseptic solution. Then the affected areas are blotted with napkins until the wound is as dry as possible. A mixture of powders is prepared, consisting of the drug “Celoform”, which includes modified cotton cellulose, and the drug “Streptocide” (sulfonamide). The drugs are mixed together 1:1. The mixture of powders is distributed around the stoma onto the affected areas, and a colostomy bag is glued on top.

The mixture of powders is used as a protective and healing dressing and promotes the absence of swelling and pain, and also creates optimal conditions in the wound for granulation and epithelization, allows for a favorable course of the postoperative period (closure of the stoma) and good treatment results, and it has also been established that that the use of modified cotton cellulose and sulfonamide, as a means for topical application of inflammatory complications, promotes faster cleansing and the formation of soft scars after healing.

The mixture of powders is kept on the affected areas for 3 days.

To evaluate the effectiveness, a study was conducted that included 20 patients with paracolostomy fistulas. All patients showed high efficiency of healing, and the release of free pus stopped. Part of the turunda remains practically dry, since the wound discharge is absorbed by the drug on the turunda, which allows the colostomy bag not to come off and does not create inconvenience for the patient.

Clinical example 1.

Patient I. 65 years old. An emergency operation was performed to remove a single-barrel colostomy for acute intestinal obstruction. After the patient was discharged from the hospital, the patient was unable to independently cope with the colostomy treatment technique at home. Two weeks later, the patient developed skin dermatitis due to the chemical effects of intestinal discharge. Itching and burning occurred. Upon examination of the patient, it was determined that there was redness and oozing ulcers around the stoma. Afterwards, the infected skin was treated with an antiseptic solution, then a mixture of Celoform and Streptocide powders in equal proportions was applied, onto which a colostomy bag was subsequently glued for three days. The dressings lasted for two weeks until complete healing.

Clinical example 2.

Patient K., 56 years old, came to the rehabilitation office for ostomy patients. On examination, he has a single-barreled sigmostoma with several parostomal complications. There is partial retraction of the colostomy, there are threads of non-absorbable suture material that were not removed in time. Fistula tracts and microabscesses began to form around the ligatures. Due to partial retraction of the stoma, caused by the fact that its application was carried out by suturing the edges of the aponeurosis and skin, a chronic wound filled with hypergranulations formed around it. Caring for such a stoma and wearing a colostomy bag becomes impossible. The sutures were removed, hypergranulations and hypertrophied areas of the skin were removed, dressings were carried out once every 3 days with the drugs Celoform and Streptocide. During treatment, the fistula tracts began to heal, and microabscesses were drained. By eliminating hypergranulations from the edges of the wound, epithelization of the skin defect began. On the 15th day after treatment, the skin defect was completely epithelialized, the intestine began to take the form of a “column”, but fresh scars are still dense, dark red in color. On the 26th day, the skin had completely healed, the scars had matured and become elastic, they had taken on a light color, and the intestine had completely taken on the appearance of a “column.”

Claims (1)

A method for treating complications caused by inflammation of a colostomy, including washing the wound with an antiseptic solution, characterized in that the festering suture material or tube for fixing the stoma is removed, the wound is dried with napkins, a mixture of Celoform and Streptocide powders in equal proportions is sprayed onto the affected areas around the stoma, and a mixture of Celoform and Streptocide powders is sprayed on top of it colostomy bag, dressings are carried out once every 3 days until the wound heals.