A jejunostoma (Latin jejunum = “empty intestine” and Greek stoma = “mouth“) refers to a connection created by surgery between the jenunum (upper small intestine) and the abdominal wall for insertion of an intestinal tube to allow etheral (artificial) feeding of the patient.
What is the jejunostomy?
A jejunostoma refers to a connection created by surgical means between the upper small intestine and the abdominal wall for insertion of an intestinal tube to provide artificial nutrition to the patient. This procedure is mainly performed in colorectal cancer patients. Depending on the severity of the disease, it may be necessary to surgically remove larger portions of the colon. In most cases, the placement of an artificial bowel outlet is necessary because the function of the colon is eliminated, resulting in decreased absorption of electrolytes and water loss. The result is mushy and thin stools and increased stool frequency. Any ingestion of food results in evacuation. Closely related to the jejunostoma is the ileostoma, when the remaining bowel is passed to the abdominal skin and ends in the lower part of the ileum (small intestine). If the end of the bowel is in the higher section of the small intestine (jejunum), a jenunostoma is present. In both cases, physicians have performed a bowel resection (removal of the colon). The second option, after removal of the colon, is to place a connection between the anus and the small intestine without creating a permanent artificial bowel outlet. This procedure is referred to in medical terminology as an ileoanal pouch or ileo-pouch-anal anastomosis (IPAA).
Function, effect, and goals
Stomata are placed terminally or double-ended. With the terminal stoma, the surgeon pulls the upper loop of bowel through the abdominal wall to the surface, leaving a small section of bowel protruding. Often, the lower section of bowel must be removed. A double-barreled bowel outlet is placed by pulling the bowel loop through the abdominal skin and then cutting it open. Both intestinal openings are now on the outside and are sutured into the abdominal skin. Intestinal stomas serve to relieve the remaining part of the intestine, since it now no longer discharges stool. They interrupt the intestinal passage and are usually placed only temporarily. A Jenustoma is placed whenever major portions of the rectum (rectal), including the anal sphincter, need to be removed. Without the sphincter, the patient is no longer able to control bowel movements. Most patients find an artificial anus very stressful. They are forced to get used to it in their daily lives. From a medical point of view, it is possible to live “normally” with a jejunostoma, although this term is of course open to interpretation and the affected patients may subjectively perceive their situation differently. From a purely medical point of view, the colon is not an organ that is necessary for the patient’s survival, like the kidneys, the heart or the lungs. Its main purpose is to fatten and thicken the stool. If this organ has to be partially removed, there is no risk of limited life expectancy. Particularly in the first few months after surgery, patients’ daily lives change enormously, as they have to get used to their artificial bowel outlet and adjust their habits accordingly. Many patients need a longer period of time to get used to their altered digestive system, while others are unable to come to terms with their artificial bowel outlet. The extent to which these restrictions are perceived as burdensome always depends on the individual life situation. From the patient’s point of view, an artificial bowel outlet always represents a greater burden than a colon that has merely been shortened. This is a “short circuit” between the small intestine and the anus. There is no health risk, the stool becomes more liquid because the thickening process is missing. If this short circuit is not possible, an artificial anus (jejenustoma) is placed. The small intestine ends in a small opening in the abdominal skin. A stoma is induced in the following diseases: Crohn’s disease and ulcerative colitis (chronic intestinal inflammation), inflammation caused by protrusions of the intestinal mucosa (diverticulitis), Hirschsprung’s disease (congenital malformation of the intestine), intestinal injuries, for example due to accidents, insufficient or absent sphincter function, intestinal perforation, postoperative complications and congenital colon polyps.With the artificial anus, a loop of bowel protrudes from the abdominal cavity. A plate is placed around the exit site to protect the affected skin. The stoma bag, which catches the escaping stool, is attached to this point. A distinction is made between one-piece and two-piece systems. The one-piece system connects the base plate and pouch firmly together; they can only be changed together. The two-piece system guides the plate and bag separately, and they can also be changed independently. The advantage of this system is that the base plate on the skin does not need to be changed daily, but remains there for a few days. The aim of the jejunostoma is to bypass the natural digestive process, since the stool is not passed out through the anus, but is diverted to the artificial anus through the abdominal wall. This procedure “immobilizes” parts of the intestine and the healthy part remains intact. After the operation, in many cases a nutritional therapy is carried out in order to adapt the organism to the changed digestive situation. In order to bridge this acclimatization phase, nutritional therapy supplies the patient with important nutrients by means of infusion. It compensates for nutrient loss of minerals such as potassium, sodium, and magnesium and for water loss.
Risks, side effects, and hazards
In Germany, approximately 100,000 people live with a permanent or temporary stoma. From a medical point of view, there are no health restrictions because the colon is not a vital organ. Nevertheless, in the first period there is a change that takes some getting used to due to the “diverted” bowel movement. Many patients cope well with this change, a large part is purely a matter of the head, according to the doctors. Nevertheless, many of those affected report considerable side effects, which are not only medical but also social in nature. Many young people under the age of thirty have to live with an artificial bowel outlet after colon removal. In most cases, the organ was removed due to degenerated polyps. These patients complain about restrictions in their social contacts and that they can no longer have “normal” relationships, especially in sexual terms. Activities with friends are very limited due to the changed nutritional situation. However, the greatest side effect of the stoma is chronic soreness of the skin areas directly affected by the intestinal stoma. Wound complications occur especially if the base plate is not cut properly and cannot protect the skin environment from the aggressive stool. Various pastes and creams are available for wound care, and cleaning is performed using fleece compresses and pH-neutral soap. Wound care is described by many patients as complicated; several changes of plaster or dressing per day are necessary if the affected areas become oozing. A large number of stoma patients have experienced that the professional staff, for example stoma nurses in hospitals, are overwhelmed with wound care due to lack of time. They have the option of having expert wound care prescribed for them in bowel centers or by expert nursing staff in the outpatient clinic via their family doctor. In some cases, severe post-operative complications such as infections occur, necessitating a prolonged hospital stay.