The term enterostoma is the medical term for the “artificial intestinal outlet”. This is referred to as either anus praeter naturalis (Latin) or intestinal stoma, or stoma for short (Greek : mouth, opening). The creation of an enterostoma is a visceral surgical procedure (abdominal surgery) and often a partial measure of intestinal surgery, e.g. in the removal of a carcinoma (malignant tumor) in the intestine. The goal is to drain stool and gases produced during digestion through the abdominal wall via a segment of intestine that is surgically passed to the surface. An enterostoma is required when the physiological intestinal passage is not possible or not preserved, or when inflammatory diseased or freshly operated intestinal segments have to be spared. This text gives an overview of indications, contraindications and general characterizing aspects of the enterostoma. For surgical creation of the artificial intestinal outlet, see “Enterostomy creation.”
Indications (areas of application)
- Inflammatory colonic diseases:
- Ulcerative colitis (inflammatory bowel disease (IBD)),
- Complicated diverticulitis (inflammation of the intestinal diverticula in the context of diverticulosis – diverticula are small outpouchings of the intestinal wall),
- Radiation colitis (during radiotherapy treatment, for example, a carcinoma, it can come to an inflammation of the intestine).
- Removal of the sphincter muscle (sphincter ani) in the anal region.
- Suture insufficiency (suture weakness) after anastomosis (joining) of two ends of the intestine, for example, after tumor resection.
- Mechanical colonic ileus (large bowel obstruction) due to neoplasia (new formation) in:
- Rectal carcinoma/bowel cancer (distal),
- Anal carcinoma,
- Peritoneal carcinomatosis (synonyms: carcinosis peritonei, peritonitis carcinomatosa; extensive infestation of the peritoneum with malignant tumor cells) with obstruction (narrowing) of the colon (large intestine).
- Postoperative (after surgery) – To improve the healing of affected sections of the intestine.
- Fecal incontinence (inability to withhold diapers or bowel movements arbitrarily).
- Trauma (injury) to the colon, such as impalement injuries.
Contraindications
The therapeutic decision for an enterostoma is usually a situation without alternative. The creation of an enterostomy is only indicated (indicated) when other therapeutic measures have been exhausted. If the indication is correct, general contraindications apply to the abdominal surgical procedure.
Procedures
An enterostomy can be placed either temporarily (for a limited time) or permanently. Temporary creation of an artificial bowel outlet is sought to be protective (protective) during surgical procedures distal (located further peripherally) to the planned stoma. Another temporary application is in the so-called emergency Hartmann situation. Partial colon resection (removal of parts of the colon) according to Hartmann is performed to remove the deep sigmoid (terminal part of the colon) as well as the rectum (rectum) in case of disease processes in this area. In this procedure, the rectum is blindly closed and a sigmoidostoma (stoma in the area of the scrotum) is created. In the case of acute so-called sigmoid diverticulitis (inflammation of the scrotum), this operation can be performed as an emergency and, in the further course, the stoma can be repositioned (i.e. the connection between the sigmoid and the rectum is surgically restored). Usually, a temporary anus praeter can be repositioned after 6 weeks to 6 months. The creation of an anus praeter becomes permanent if the patency of the intestinal passage cannot be restored. This may be the case, for example, in extensive tumorous events when anastomosis of the bowel ends is not possible. A further distinction between different enterostomata must be made according to the site of creation. The following stomas are distinguished here:
- Ileostoma (diversion from the ileum/rum or hip bowel)).
- Colostomy (expulsion from the colon/large intestine) – terminal or double-barreled.
Special forms of colostoma:
- Transversostoma (artificial anus praeter of the transverse colon (colon transversum)) – left-sided or right-sided.
- Sigmoideostoma (discharge from the sigmoid/sigmoid loop, called sigmoid colon or sigmoid, is the fourth and last part of the human large intestine).
- Cecostoma
A so-called ileostoma is created in the area of the ileum, while a colostoma is located in the area of the colon. Here it can be located in the ascending colon (ascending colon), transverse colon (transverse colon; transversostoma) or descending colon (descending colon). The colostomy comes in two varieties: A double-barreled colostomy has an inflow and outflow leg of a bowel loop that are passed to the abdominal wall, while a terminal colostomy, which is created when the rectum and anal canal, including sphincter (sphincter muscle), are removed, has only one leg. If the rectum is preserved, this anus praeter can in principle be moved back (see above: Hartmann situation).
Possible complications
- See below Enterostomy creation (creation of an artificial bowel outlet).
