An enterostomy is an artificial intestinal outlet on the abdominal wall for temporary or permanent evacuation of intestinal contents, as may be required for colorectal cancer patients, patients with inflammatory diseases such as Crohn’s disease, or patients with intestinal sutures. The procedure is usually performed under general anesthesia and, in addition to the typical anesthetic risks, is associated primarily with the formation of internal hernias, although an experienced physician can usually avoid this by taking special precautionary measures. Enterostomata either remain permanently or are repositioned within a few weeks, so especially if they are intended only to temporarily relieve the pressure on a section of intestine.
What is the enterostomy?
An enterostomy is an artificial bowel outlet on the abdominal wall for temporary or permanent evacuation of bowel contents. An enterostomy is the medical term for an artificial intestinal outlet in the abdominal wall that is used to expel intestinal contents. In this context, a stoma always corresponds to an artificially created hollow organ opening to the surface of the body. The red and moist enterstoma protrudes from the abdominal wall and can be either permanent or temporary. The physician differentiates between ileostomata, coecostomata, colostomata and transversostomata according to the section of intestine used. The ileostoma is one of the most common forms and corresponds to an exit from the scrotum. A deep loop of small bowel is usually used for this purpose, and the outlet is usually through the ceiling of the right lower abdomen. Both ileostomata and colostomata – an artificial exit from the colon – can be created temporarily or permanently. The special form of transversostoma is again an artificial outlet from the middle part of the colon, which can also be created continuously or discontinuously. Finally, the coecostoma is an outlet from the appendix. In all cases, the surgical procedure to place the enterostoma can be called an enterostomy. Such an operation can be performed either terminally or double. A terminal procedure is necessary if parts of the intestine had to be removed beforehand. A double-barreled enterostomy, on the other hand, is often used for intestinal sutures that require temporary relief of the bowel. Within Germany, it is estimated that more than 100,000 people of various age groups wear enterostomata.
Function, effect, and goals
Indications for an enterostomy may include a variety of conditions. Among the most common, the procedure is performed in bowel dysfunction, colon cancer patients, or patients with hereditary colon polyp disease. However, carcinomas in another localization between the thorax and the pelvis may also require the intervention, for example bladder or uterine cancer. Under certain circumstances, the intestine may also have been damaged by a previous trauma, so that the doctor had to remove parts of it, or an inflammatory disease such as Crohn’s disease may have caused considerable damage to certain regions of the intestine. The surgery takes place under general anesthesia. Before the operation, the doctor draws the ideal position of the stoma on the patient to ensure that the opening will not later cause any discomfort when the patient is sitting, lying or standing. As a rule, the doctor uses an abdominal incision, i.e. a laparotomy, to relocate the stoma. If a major surgical intervention is not necessary, a minimally invasive procedure during laparoscopy, i.e. laparoscopy, is used for the transfer. In the case of a colostomy, the stoma is transferred without tension and in a slightly protruding position in the straight rectus abdominis muscle. The doctor fixes the colon mesentery to the abdominal wall. If an ileostomy is required, the physician places the feeding stoma leg through the small intestinal bulge with an orientation downwards. He takes care that the stoma protrudes several centimeters above the skin, otherwise the secretion of the small intestine can cause skin irritation. A terminal enterostoma is sutured to the outside of the abdominal wall and is not usually repositioned. A double-barrelled stoma is usually repositioned after a few weeks, since the purpose of this procedure is merely to relieve the bowel for a certain period of time. This operation differs from the procedure just described in that the functioning bowel is removed from the abdominal incision and provided with the respective openings for the stoma.In the case of both a double and terminal enterostoma, the placed system corresponds to either a one-piece or a two-piece system. In a one-piece system, the skin protection plate and the pouch form one unit. In contrast, with a two-piece system, the physician attaches the plate and pouch separately to the ceiling of the abdomen.
Risks, side effects, and hazards
In addition to the conventional risks of general anesthesia, enterostomy is primarily associated with the risk of internal herniation, which is the passage of abdominal tissue through an opening in the abdominal wall. In the course of this, there may also be a displacement of organs from the abdominal cavity through the stoma. In turn, a prolapsed bowel can cause the stoma to no longer close tightly. If the abdominal folds are in a sitting position, wounds may possibly occur after the operation because excretions collect in the folds. Under certain circumstances, the stoma can also move back into the abdomen after the operation and thus disappear under the skin. Although these risks do exist, the enterostomy is still considered a relatively safe operation overall and is part of a surgeon’s daily routine. Prior to the operation, extensive care of the patient by specialist staff plays a major role. This includes, for example, advice on the subsequent diet, which can only be re-established slowly and initially requires, for example, the avoidance of high-fat foods or hot spices. Depending on the system chosen, the stoma is later fitted with either an open or closed pouch. Open pouches are emptied regularly by the patient, while closed pouches are discarded and replaced with new pouches. This procedure is also explained to the patient in advance by the specialist staff. If a return transfer is planned, an appointment may be scheduled at this time. The relocated stoma will be checked regularly after surgery to ensure that it does not slip below the skin level.
