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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_985_Библиотеки_им_академика_М_И_Перельмана.pdf
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Fig. 14.9 Unmatured ileostomy-serosal granulation tissue
a
Fig. 14.11 Skin-grafted ileostomy
b
Fig. 14.10 Skin-grafted ileostomy. ( a ) Courtesy Frank L. Weakley,
MD. ( b ) Courtesy Victor Fazio, MD
Fig. 14.12 Loop cecoileostomy. The third orifi ce is the appendix
162 V.W. Fazio et al.
ab
Fig. 14.13 ( a ) Continent ileostomy and intubation tube managed by patient. ( b ) Continent ileostomy with dressing
Fig. 14.14 Blowhole colostomy ( arrow ), loop ileostomy in a patient
with toxic megacolon
Fig. 14.16 Subcutaneous stoma support rod (courtesy Rupert B.
Turnbull, Jr., MD)
Fig. 14.15 End ileostomy and exteriorized rectosigmoid after subtotal
colectomy for toxic colitis. The rectosigmoid is secured above the skin
with gauze to prevent retraction back into the abdomen; maturation to a
mucous fi stula is delayed
Fig. 14.17 Ileostomy, profuse granulomatous tissue
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Fig. 14.20 Ileostomy polyp in a patient with familial adenomatous
polyposis
Fig. 14.18 Crohn’s ileitis. Note ulceration ( arrow )
Fig. 14.19 Colostomy affected by Crohn’s disease; patient underwent
completion proctocolectomy and ileostomy
Fig. 14.21 Pseudomembranes on ileostomy in a patient with
Clostridium diffi cile enteritis
Fig. 14.22 Ileostomy, mucosal trauma from pressure
164 V.W. Fazio et al.
Fig. 14.23 Ileostomy, mucosal trauma-appliance aperture too small
ab
Fig. 14.25 ( a ) Ileostomy, marginal ischemia. ( b ) Ileostomy, local revision, excision of devitalized tissue
Fig. 14.24 Mucosal ischemia
Fig. 14.26 Ileostomy, ischemia
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Fig. 14.27 Gangrenous end sigmoid colostomy
Fig. 14.28 End ileostomy, neurofi bromatosis (von Recklinghausen’s
disease)
Fig. 14.29 Ileal conduit, acute contact dermatitis due to urine leak
Fig. 14.30 Chronic reactive dermatitis to stoma bag
166 V.W. Fazio et al.
Fig. 14.31 Ileal conduit, leakage, skin destruction caused by contact
of skin with urine
ab
Fig. 14.32 ( a ) Ileal conduit, vitiligo. ( b ) Ileal conduit, vitiligo, melanin returning
ab
Fig. 14.33 ( a ) End ileostomy. Mechanical trauma from sutures. ( b ) End ileostomy after suture removal
ab
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Fig. 14.34 ( a ) Intestinal mucosal implants along parastomal needle tracks (macroscopic). ( b ) Intestinal mucosa implants along parastomal nee-
dles tracts (microscopic)
Fig. 14.35 Ileostomy, caput medusae
Fig. 14.36 Ileostomy, partial mucosal separation
168 V.W. Fazio et al.
Fig. 14.37 Transverse colostomy, peristomal granulation tissue
Fig. 14.38 End descending colostomy, total mucosal separation
Fig. 14.39 Pseudoverrucous lesion due to chronic hydration of the
peristomal skin
Fig. 14.40 Stoma too close to midline incision. This situation increases
the risk of leakage and wound infection. A fungal rash is seen around
the incision
ab
Fig. 14.41 ( a ) Ileal conduit, folliculitis due to depilation from traumatic removal of skin barrier. ( b ) Ileal conduit, folliculitis resolving with cor-
rect pouching and antibiotic treatment
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Fig. 14.42 Peristomal ulcer extending laterally from stoma. The base
is granulating; the edges are shelved with a tendency to undermine
Fig. 14.44 Mechanical trauma from stoma plate
Fig. 14.43 Pyoderma gangrenosum adjacent to an ileostomy in a
patient with infl ammatory bowel disease. The base of the ulcer shows
the typical black ulcer refl ective of necrosis
170 V.W. Fazio et al.
a
b
a
b
Fig. 14.45 ( a ) Tension on ileostomy exacerbating skin crease. ( b )
Loop ileostomy, recessed stoma after removal of support rod
Fig. 14.46 Loop jejunostomy, location in skin crease resulting in leakage and skin destruction
c
Fig. 14.47 ( a ) Ileostomy in a skin crease, sitting. ( b ) Ileostomy in a
skin crease, supine. ( c ) Ileostomy in a skin crease, corrected by stoma
relocation