A stoma, also known as a stoma or fistula, is the opening of the mouth of internal organs through the skin. The creation of a stoma can be a part of the treatment of diseases of the digestive tract, urinary system, bile ducts and other organs. Find out what types of stoma are, what are the indications for a stoma, what is the care of a stoma and what complications can be associated with a stoma.

Stomia - what is it?

Stoma (Greek - hole) - is a deliberately created connection between the internal organ and the external surface of the body.

A stoma is designed to replace the function of organs that are temporarily or permanently unable to drain excreta from the body. The most common type of stoma is the intestinal stoma, also known asartificial anus .

Stomia - types

A stoma is an artificial, intentionally created outlet of an internal organ to the outer surface of the body. Most often, the stoma is located on the surface of the skin. In some cases, the stoma may develop within the mucosa.

Most stomas work to drain waste products outside the body. This is how stomas created in the intestines and urinary tract work.

Some specific types of stoma may have different functions. Part of the stoma is made to put certain substances into the body. This is how, among others, A nutritional gastrostomy that allows food to be fed directly into the stomach.

The stoma is a procedure used to treat diseases of many organs. Different types of stoma have separate names, depending on their location and the organ in which they were produced.

Types of stoma:

  • The intestinal stoma is the most common type of stoma . Depending on the section of the intestine that has been connected to the skin, we can either meetan ileostomy or a colostomy . They represent stomas in the small or large intestine, respectively.
  • Within the digestive tractless commongastrostomy(connection of the stomach to the skin), duodenostomy (connection of the duodenum to the skin) andbiliary stoma .
  • Apart from diseases of the gastrointestinal tract, stomas are relatively often used in the treatment of diseases of the urinary tract. The urine drainage stoma is calledurostomy .
  • The discharge of urine outside the body can take place at the level of various organs of the urinary system. The connection of the lowest level of the urinary system, i.e. the bladder with the skin, is calledcystostomy .
  • A stoma within the ureters is calledureterostomy . Urine drainage is also possible on the top floor of the urinary tract, i.e. directly from the inside of the kidneys. The connection of the renal pelvis to the skin isnephrostomy .
  • A special type of stoma, most often found in ICU settings, istracheostomy . A tracheostomy is the opening that connects the front of the trachea to the skin. Tracheostomy provides adequate access to the airway, which plays a huge role in patients requiring respiratory support. Tracheostomy is mainly produced in patients undergoing long-term mechanical ventilation. Supporting breathing through a tracheostomy allows you to avoid, inter alia, pressure ulcers in the airways caused by prolonged use of the tracheal tube.

Stomia - indications

The primary use of a stoma is to replace the function of the organ that transports waste products out of the body. This is how intestinal stomas and urinary tract stomas work, draining feces or urine, respectively.

The indications for a stoma may be temporary or permanent.Temporary stopshave a function of decomposing a given organ, they allow for its regeneration or healing. After the organ's normal function is restored, a temporary stoma can be eliminated.

If it is necessary to permanently remove a given organ (most often in the course of neoplastic diseases),stomacanpermanentlyreplace its function.

According to various estimates, about 50,000 patients with a stoma live in Poland today. The most common are intestinal stomas, obtained during surgical procedures involving the intestines.

Intestinal stoma

The common indication for an intestinal stoma is colorectal cancer, requiring partial removal of the intestine. In many patients, surgery for colorectal cancer makes it impossible to restore the continuity of the gastrointestinal tract. In this situation, the stoma toAt the end of life, it acts as an artificial anus, allowing the evacuation of fecal content.

Other indications for an intestinal stoma include :

  • inflammatory bowel disease (Crohn's disease, ulcerative colitis),
  • as well as acute intestinal diseases (obstruction, perforation, abdominal injuries).

Many urgent intestinal surgeries result in a temporary stoma above the operated section. This procedure enables the anastomosis to heal and reduces the risk of postoperative complications. After the bowel anatomy is restored, the temporary stoma can be closed.

Urostomy

As with intestinal stomas, most urostomes (stomas that drain urine) are produced by surgery to treat cancer.

If the patient's illness requires the removal of parts of the urinary system, the continuity of the urinary tract may be permanently disrupted. The only way to drain the urine then is through a permanent urostomy.

Urostomy can also be a temporary stage in the treatment of many acute urological diseases. Sudden blockage of the urine outflow (for example - due to an injury or urolithiasis) causes urinary retention, an increase in pressure in the urinary tract and the risk of further damage to the urinary system.

A temporary urostomy allows you to drain the urine and gives you time to properly treat the underlying disease.

Percutaneous nutritional gastrostomy

Although most stomas are designed to drain waste products outside the body, there are also stomas that have different uses. An example of a stoma with a non-standard function ispercutaneous endoscopic gastrostomy , abbreviated to PEG (PEG).

Gastrostomy is the connection between the skin and the inside of the stomach. A PEG is a special type of stoma that is used to introduce food into the digestive tract. Percutaneous nutritional gastrostomy is used in patients who, for various reasons, are unable to consume food by mouth on their own.

PEG enables the nutrition of patients with diseases of the initial section of the gastrointestinal tract and with swallowing disorders. The example of PEG shows that the use of stoma in modern medicine is constantly expanding. Stomas can be used not only to drain excreta from the patient's body, but also to introduce substances into the body.

What does a stoma look like - photos:

See the gallery of 6 photos

Stomia - emergence procedure

There are many factors that influence the proper functioning of the stoma. Patient education and proper stoma care are essential to avoid possible stoma-related complications. It is worth knowing, however, that the method of selecting the stoma is equally important.

When performing an intestinal stoma, the so-called the principles of a good stoma. The creation of a stoma involves incision of the abdominal wall, proper preparation of the intestine and then sewing it to the skin.

From the point of view of the later functioning of the stoma, the most important thing is its proper location, as well as the way the intestine is attached to the skin. The section of the intestine where the artificial anus is created should be properly supplied with blood. The intestine should be separated from other tissues in such a way that it can be sewn to the skin without excessive tension. This avoids retraction of the stoma later.

The stoma site should be easily visible and accessible to the patient to allow for daily care. The stoma is always created under aseptic conditions. The first ostomy pouch is placed in the operating theater. In the first days after stoma placement, the surgical wound, the area around the stoma, and the material that comes out of it, must be inspected regularly.

Stomia - care

Patient education in the care of a stoma is one of the key stages of life with a stoma. Proper stoma care is essential for its proper functioning and for avoiding periostomy complications. A patient with a stoma should be looked after not only by a doctor, but also by a stoma nurse.

Currently, there are stoma clinics throughout the country that provide advice on ostomy care. Patient education begins right after the stoma is selected, before leaving the hospital.

The ability to test different variants of ostomy appliances (including ostomy bags / ostomy bags) and customize them individually to the patient plays an important role. After returning home, the patient should be able to care for the stoma on his own.

If you have any doubts, problems with the operation of your ostomy appliance or unforeseen situations, it is a good idea to ask your stoma nurse for help or make an appointment at the stoma clinic.

Ostomy equipment care

The basic principles of stoma care are common to all types of stoma. The ostomy appliance should be individually adjusted to the patient. There are many variants available on the market today. Ostomy bags can be disposable (they need to be completely replaced afterfilling) or the so-called permeable (allows you to remove the contents without the need to change the bag each time).

Ostomy appliances can be one-piece (a bag with a built-in skin adhesive) or two-piece (a separate bag and a wafer attached to the skin). In addition to the regular replacement of ostomy bags, make sure that they stick tightly to the skin surface.

Stoma skin care

The skin around the stoma is particularly vulnerable to the irritating effect of stoma excrements. For its care, do not use irritating agents or strong detergents.

In maintaining hygiene, special products dedicated to sealing and care of the stoma area can be helpful. Correctly selected and properly placed ostomy bags allow you to undertake your standard life activity.

Stoma care in the large intestine

The type of stoma and how the stoma functions depends to a large extent on where it is located. In the case of intestinal stomas, the closer the stoma is to the natural anus, the better the rhythm and consistency of bowel movements is maintained.

Stomas at the end of the large intestine allow for the expulsion of thickened feces. The sooner a stoma is created along the course of the intestine, the less dense fecal content and the greater the content of irritants in the stoma.

Stoma care in the small intestine

The stoma on the small intestine requires the most attention from the patient. The digestive enzymes contained in the intestinal juice additionally irritate the skin around the stoma, which is why in the case of "high" stomas it is necessary to adjust the ostomy equipment and care for hygiene.

Thorough drying and care of the skin around the stoma is also important in the case of a urostomy. Most urostomes work by flowing urine continuously into the ostomy bag. Proper protection of the skin against contact with urine reduces the risk of irritation and wounds in the area of ​​the stoma.

Stoma - complications

Each stoma disturbs the normal anatomy and physiology of the organs, and therefore carries a risk of complications. Stoma complications can arise from improper stoma development or inadequate care.

Most of them, however, do not arise as a result of the surgeon's or the patient's own error. Sometimes, even though your stoma is properly made and operated correctly, you may develop undesirable symptoms. The most common pathologies associated with a stoma include:

Early periostomy complications

A stoma is a surgical procedure that carries the risk of early complications, similar to other types of surgery. In the area of ​​a newly created stoma, there may be bleeding, infection of the surgical wound, and suture separation.

If the blood circulation in the stoma is disturbed, it may develop ischemia or even necrosis. For this reason, a newly established stoma is regularly checked.

Most of the early peristomal complications can be detected during the patient's hospitalization. Many of the problems associated with stoma healing can be successfully treated conservatively. In case of serious complications, a second surgical procedure may be necessary.

Skin lesions around the stoma

Skin irritation around the stoma affects many stoma patients. Skin inflammation is mainly due to contact with irritating stoma secretions. It is worth knowing that a properly selected and cared for stoma significantly reduces the risk of such complications.

The most important thing is that the ostomy appliance is tightly bonded to prevent contact of the stoma with the skin.

In the event of recurring inflammation of the skin, it is worth trying other variants of the equipment. The skin care around the stoma can be supported with dedicated cosmetics. If the inflammatory lesions become infected, it may be necessary to use an antibiotic or antifungal agents.

Stoma narrowing

Stoma stenosis is a complication that can result from the stoma not healing properly, inflammation, or errors in stoma fabrication. Mild stoma stenosis can be manifested as reduced excretion from the stoma.

The more severe the stenosis is, the more content remains unremoved. Extreme narrowing of the stoma can lead to intestinal obstruction with blockage.

Early stoma stenosis gives a chance for effective conservative treatment (for example, by inserting a finger into the stoma). A severely narrowed stoma may require surgical repair.

Parastomal hernia

Parastomal hernia is one of the most common complications of late stoma. Anyone with a stoma is at risk of developing a parastomal hernia. A stoma requires an unnatural opening in the abdominal cavity, which is why it is a predisposition to hernia.

This risk is increased in obese patients, with impaired parostomy wound healing, and in an incorrectly positioned stoma.

Small hernias are treated initiallyconservatively. Avoid situations that increase abdominal pressure (such as lifting heavy objects). It is also worth getting a hernia belt.

If the hernia carries a risk of further complications (including intestinal entrapment), surgical management is necessary. Currently, most parastomal hernias are secured by sewing a special mesh supporting the contents of the abdominal cavity.

Short Bowel Syndrome

Short bowel syndrome is a complication not of the stoma itself, but of the accompanying removal of a large part of the bowel. Short bowel syndrome mainly affects patients with a stoma in the small intestine. The earlier the stoma is created, the shorter the length of the intestine performs its function (digestion, nutrient absorption).

Short bowel syndrome can lead to bothersome diarrhea, which results in a loss of water and electrolytes from the body.

Patients with short bowel syndrome are at risk of deficiency of vitamins A, D, E, K and B12.

Short bowel syndrome requires a special diet and nutrient supplementation. If there is a risk of severe malnutrition, specialized nutritional treatment (e.g. parenteral nutrition) is necessary.

Psychological complications

The stoma surgery is a great experience for every patient. Most people are afraid of later functioning in social relationships, further life activity and sexual life. Some patients with an ostomy develop depressive disorders and anxiety disorders.

It is worth remembering, however, that proper education allows you to master stoma care in such a way as to be able to lead the current lifestyle. The experiences of other patients with a stoma (Polish Stomijne Society Pol-Ilko, STOMAlife Foundation) may be useful in adapting to the new life situation. In the case of persistent mood and emotional disorders, it is worth using psychological support or going to a psychiatrist.

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Category:

Gastrology