Definition
Anus praeter is the outdated technical term for the artificial anus. As this name suggests, an artificial anus was surgically created through the abdominal wall to allow continued excretion of stool and/or to spare the subsequent bowel segments affected by disease or surgery. An anus praeter can be created for final defecation or temporarily (for a certain time).
Depending on where the anus praeter drains the stool or where the artificial bowel outlet is, a distinction can be made between ileostoma, coecostoma, transversostoma or colostoma. The transversostoma is an anus praeter which is placed on the transverse colon (transverse colon, colon transversum) in order to relieve the following bowel segment. An ileostoma diverts stool from the ileum, which is a part of the small intestine (duodenum).
A colostomy drains it from the sigmoid colon (sigmoid colon). A rare relieving stoma is the coecostoma. It is a stoma system in the area of the appendix (coecum).
Indication
There are various reasons (indications) for the use of an anus praeter. An ileostoma can be An ileostomy can be created after removal or partial removal (resection) of the large intestine (colon). The main reason for removal is usually cancer of the colon or rectum.
Here it may be that the sphincter muscle at the end of the colon must also be removed. This leads to the fact that the stool can no longer be held back and unintentional defecation (fecal incontinence) occurs. To prevent this, an anus praeter is applied and the intestinal outlet (anus, anus) is closed.
If the conservative therapy becomes ineffective or complications occur, these indications for removal of the colon and anus praeter may arise: An anus praeter can also be temporary. If, for example, the lower part of the colon is removed due to cancer, but it is possible to connect the lower part of the colon directly to the sphincter muscle, an anus praeter is applied to spare this area or the suture for the time being. After the (suture-) healing the anus praeter can be closed or removed (repositioning).
Until the repositioning is done, anus praeter patients should be aware that it may take some time until the repositioning is done and that it may take a while after the repositioning until normal excretion is restored. – Ulcerative colitis: a chronic inflammation of the colon
- Colon cancer
- Crohn’s disease: a chronic inflammation of the gastrointestinal tract, especially the small intestine (duodenum) and colon. – Malformations: e.g. a congenital intestinal obstruction (intestinal atresia)
- Intestinal obstruction (ileus)
- Diverticulitis: an inflammation of the colon caused by a protrusion of the colon mucosa
- Fecal incontinence in neurological diseases
When can an anus be moved back later?
In an anus praeter one has to distinguish whether a permanent installation is being made or whether a relocation is planned in the course of time. After some operations, such as the permanent removal of the anus, the anus praeter must be preserved until the end of life. In most cases, however, the intestinal passage can be restored and the anus praeter can be repositioned after a while.
In most cases, an anus praeter is not moved back until the wounds have healed. This means that a temporary anus praeter usually remains in place for at least 6 weeks and can then be removed. If an anus praeter is fitted because of problems in wound healing during an operation on the bowel, the period of time can be much longer.
A typical complication of bowel surgery is insufficient closure of the bowel, which leads to infections. If an anus prater is created because of this complication, it must remain in place until everything has healed. Only then can the anus prater be relocated.
The repositioning of an anus praeter requires another operation under general anesthesia. When the anus praeter is created, the intestine is sutured to the abdominal skin and grows together with it. When the anus praeter is moved back, this connection is separated again.
The end of the intestine that has served as the exit must then be reconnected to the intestine. This connection is also called anastomosis. After the anastomosis has been created, the patient’s food must be rebuilt very slowly so that the wound can heal well. The most important complication of this procedure is suture failure, through which germs can escape, leading to infection.
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