Postoperative outcomes among cancer patients undergoing colorectal diversion at Assiut University Hospital: suggested nursing intervention protocol

Colorectal cancer is one of the leading causes of cancer death in both developed and developing nations. Early and late problems may be faced by patients after colostomy surgery. Assessment and management of stoma complications are the responsibility of nurses across the continuum of care and played a central role in the clinical appreciation and postoperative management as evidenced by interest in managing postoperative outcomes and treating the complications. Therefore, the aim of this study was to identify the postoperative outcomes among patients undergoing permanent colorectal diversion, sixty patients were selected from the General Surgical Units in Assiut University Hospital and Upper Egypt Cancer Institute, their age ranged between 30-70 years with mean age of 50.30 +/- 11.28 yrs. Tools used for data collection were Socio-demographic and Medical Data Sheet; Physical and Social Assessment Sheet; Nutritional Assessment Form and Rosenberg's Global Self Esteem scale [RGSLs]. Structured interview was utilized for data collection. The results of the study showed that, 5% had stoma retraction, stoma fistula and mucocutaneous separation and 8.3% had stoma infection and 21.7% had skin breakdown and skin irritation. Half of the sample had gases, and 23.3% suffered from leakage. Social problems and low self-esteem were found among more than half of study subjects. The most of the patients had underweight, subnormal values of hemoglobin, albumin and white blood cells were found. The study concluded that, patients undergoing permanent colorectal diversion exhibited different physical, social, self esteem and nutritional changes and need effective measures to prevent/ reduce these complications Another further study on a larger sample and for 6 months to one year as a minim time for follow up is recommended, encourage preoperative physical, social, psychological and nutritional preparation for colostomy's patient and design a rehabilitation program for patients with permanent colostomy

Comparative study between magnetic resonance cholangiopancreatography MRCP and surgical results in evaluation of obstructive jaundice

Thirty patients with obstructive jaundice suspected clinically, 14 males and 16 females were admitted in the surgery department, Assiut University Hospital, in the period between September 1999 to September 2000. Their ages ranging from 5 to 70 years. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and MRCP. Twenty-three patients were operated upon. ERCP was done in three patients [as diagnostic, therapeutic and palliative], PTC and PTD [as diagnostic and palliative] was done in one patient. The last three patients were diagnosed by US and MRCP to have primary sclerosing cholangitis. MRCP images revealed surgical biliary obstruction in 27 cases with good quality images. It demonstrated the level of obstruction in all patients [27 cases were extrahepatic and 3 patients were intrahepatic] and diagnosed the causes of obstruction in 27 patients [13 cases were malignant, 7 were calcular, 3 primary sclerosing cholangitis, one benign stricture of common hepatic duct [CHD], one case benign stricture of common bile duct [CBD], one case stenosis of doudenal papilla and one case chronic pancreatitis]. In three patients there was distal obstruction of undetermined origin by MRCP. One patient had calcular obstructive jaundice by ERCP [false -ve] and in two patients no cause was found by surgical exploration. In this study, MRCP was found to be a helpful technique in children and also in malignant obstruction, where it enable to diagnose four early resectable cases [three with pancreatic head cancer and one patient with ampullary carcinoma]. The specificity of MRCP in this study was found to be 100%, the sensitivity 96%, the accuracy 96.5% and the success rate in diagnosis of biliary obstruction was 100%. It was concluded that, MRCP is evolving as a rapid, easy, accurate and noninvasive tool for evaluation of the pancreaticobiliary system in patients with various obstructing biliary conditions