Pediatric emergency medicine trisk 4683 4683

represent an emergency Elective surgical revision provides definitive management Complications Specific to Ileostomy Patients with ileostomies occasionally develop metabolic derangements In the face of large volume losses, children tend to deplete salt and water If large fluid losses persist, the biochemical profiles of these patients are significantly altered Determining the cause of the exceptionally high fluid losses from the ileostomy is crucial Some possibilities are obstruction, gastroenteritis, and dietary indiscretion Treatment is aimed at restoring normal fluid and electrolyte balance and may require hospital admission Patients with ileostomies are prone to acquiring urinary stones The chemical composition of stones in this scenario is different than that in normal patients; uric acid stones constitute 60% and calcium oxalate makes up the remainder Treatment is directed at decreasing ileostomy output and increasing urine output Urinary Diversions Vesicostomy In patients with a vesicostomy, eversion of a large portion of the bladder can occur and appear like an exstrophy When the posterior aspect of the bladder prolapses through the stoma, the patient presents with a red mass, which may change to purple if not treated promptly Applying an index fingertip to the bladder and gently pushing inward may manage this condition Nonlatex gloves are required because children with urologic abnormalities are often allergic to latex Sedatives may be required to facilitate reduction of the prolapse A prolapsed vesicostomy should be surgically revised emergently if the manual reduction is unsuccessful Patients with stomal stenosis of the vesicostomy usually present with a palpable bladder, a history of unwanted urethral voiding, or with symptoms of urinary tract infection As the bladder fails to empty at low pressures, the mean storage pressure rises and the chance for seeding bacteria into the upper urinary tract increases These patients often have a pinpoint opening to the bladder, and the parents usually comment on how much smaller the stoma has become over time If possible, these patients should have a catheter placed via the vesicostomy using a small (6F or 8F) catheter If it is not possible to catheterize the vesicostomy, an attempt must be made at urethral catheterization assuming the patient has been left anatomically intact If the vesicostomy is successfully catheterized, the catheter should be left in place until surgical revision is carried out