The word stoma, also called ostomy, emanated from the Latin word ostium, meaning the opening or mouth. An intestinal stoma is a standard surgical procedure. The exteriorization of the small bowel called an ileostomy, or large bowel, called a colostomy, through the anterior abdominal wall is executed. It is a usual life-saving procedure done in an emergency. It is done to manage benign and malignant conditions in gastrointestinal areas. It is done on an emergency basis. A stoma is done in conditions like colorectal cancer, inflammatory bowel diseases, radiation injury, colonic diverticulitis, and fecal incontinence. Intestinal stomas can be temporary or permanent. It is considered a life-saving operation procedure, and this procedure is also associated with multiple complications.
What Are the Anatomy and Physiology of Intestinal Stoma?
The small intestine lengthens from the pyloric sphincter (a ring of smooth muscle that connects the stomach to the small intestine) to the ileocecal valve (a sphincter muscle located at the junction of the ileum and the colon), and it has three segments: the duodenum, the jejunum, and the ileum. The assessed length of the small intestine is four to six meters. The duodenum is the most proximal part of the small bowel and is supplied by the superior and inferior pancreaticoduodenal arteries.
At the same time, veins also follow the arteries and drain into the portal vein. The duodenum connects the secretions from the pancreas and liver. The second part is the jejunum, the location for digestion and absorption. The last part is the ileum. The venous blood is drained through the superior mesenteric vein; it binds the vein splenic in the back of the top of the pancreas to create the vein. The large intestine lengthens from the ileocecal valve to the anus. It separated anatomically and functionally into the colon, rectum, and anal canal. The midgut is the cecum to the distal transverse colon. The superior mesenteric artery is supplied through the ileocolic, right, and middle colic arteries.
The inferior mesenteric artery supplies the hindgut. A complex vascularisation is there for the rectum. Its superior third is supplied by the superior rectal artery, which arises from the inferior mesenteric artery. Arteries from the internal iliac arteries deliver its middle and inferior third, and the Drumond borderline artery, the Riolan's turn includes significant anastomoses of arteries in the center of the inferior mesenteric and superior mesenteric artery, it gives beneficial collateral flow if stenosis, occlusion, or during oncological resections of the sigmoid colon. The venous drainage tracks the arterial supply from the inferior mesenteric vein, which binds the splenic vein. The colon's main function is water absorption and electrolyte exchange, which is important in supplying vitamins like vitamin K and B12.
An Ileostomy is created in a part of the ileum, and the output is linked to the location of the stoma. If the stoma is proximal, there is less surface area for electrolyte and water absorption. The texture is soft, affected by ingestion of nutrients, disorders including Crohn's disease, and pharmaceuticals. The ileostomy result is an average of six hundred milliliters per day.
A colostomy is a representation of the forwardly arising transverse or colon. The colostomy includes double-barrel colostomy, loop colostomy, and end colostomy. A sigmoid colostomy and transverse colostomy are the most common colostomy types. The common type of colostomy is ascending, and descending colostomies are rare. The perineal colostomy is an efficient perineal reconstruction technique after abdominoperineal resection for low rectal cancer. The contents of transverse loop colostomies are more liquid but well-formed, and the patient drains them only once a day.
What Are the Indications of Intestinal Stoma?
It is done in the treatment of disorders. Hartman's end and coil colostomy are typical stomas executed in surgical practice. Indications for these techniques vary in adults and children.
Colorectal cancer is the common cause of stoma creation in adults. Apart from this, intestinal stoma in children can handle congenital malformations of the intestine, such as Hirschsprung's disease and anorectal malformation. In adults, a few circumstances demanding intestinal stoma as a portion of their treatment is colorectal cancers, etc.
Indications of end colostomy include resection of the rectum with no restoration of continuity in peritoneal reflection malignancy. Perforating diverticulitis with fecal peritonitis and abdominoperineal rectal resection. Loop colostomy includes rectal carcinoma, which is not resectable, radiation proctitis, protective stoma in deep anterior rectal resection, incontinence, complicated rectal carcinoma with stenosis, and Complex perianal fistulas in the setting of inflammatory processes.
Indications of end or loop-end ileostomy include Hereditary nonpolyposis colon cancer with low rectal cancer, Total colectomy for refractory ulcerative colitis with medical management, and Total proctocolectomy for Crohn's disease.
The indications of loop ileostomy include protective stoma after proctocolectomy in chronic inflammatory bowel disease.
What Are the Contraindications of Intestinal Stoma?
There is no absolute contraindication for the intestinal stoma.
Carcinomatosis and short mesentery are some relative contraindications to stoma creation. Inadequate mesentery length disables the intestine's free-tension exteriorization through the abdominal wall.
Tension on the stoma, more common in obese patients, is a risk factor for developing a stoma complication.
What Are the Procedure Included in Intestinal Stoma?
Stomas are divided into two types based on the part of the exteriorized bowel: ileostomies, which include a part of the ileum, and colostomies, made utilizing only a part of the colon. Both of these can be end-ostomies, where the bowel is separated with the proximal part being utilized to develop the stoma, and the peripheral remains inside the abdomen with its end sutured- or loop ostomies, the antimesenteric wall of the intestine is partly divided.
The intestine is carried up to the skin, forming an ostomy with two openings, functional and nonfunctional. Initially, in this procedure, a circular portion of skin is removed using monopolar electrocautery, done after lifting using a Kocher clamp. Then the rectus on the anterior sheath is exposed after the separation of overlying subcutaneous fat. A cruciform incision is made on the fascia, and the underlying muscle fibers are divided.
Next, the posterior wall of the rectus sheath is revealed, and a vertical incision is made, dividing it and the parietal peritoneum. The proximal part of the bowel is then grasped with a Babcock grasper- which passes through the aperture created in the abdominal wall- and the bowel is exteriorized. The midline incision should then be closed. The bowel is restored to the skin utilizing stitches. Ileostomies are done, producing a two to three-centimeter spout protruding from the skin.
Eversion is acquired by suturing technique: four sutures are initially given through the subcuticular layer. In the second stage, entero-cutaneous anastomosis is performed using full-thickness bites of the colon wall and dermal bites on the stoma's skin. Loop ileostomy or colostomy is executed if fecal diversion is required. The procedure is similar for both operations. Care should be carried out to confirm the viability of the stoma. First, the exteriorized bowel loop is mobilized to reduce the tension exerted on the stoma. The trephine built in the abdominal wall ought to be wide enough, but care should be taken that the stoma is prone to prolapse.
Stoma formation is a life-saving procedure in handling many gastrointestinal diseases; patients suffer certain complications related to intestinal stoma. Patients undergoing stoma building mandate a group team strategy. Surgeons like rectal and pediatric surgeons are responsible for executing the operation. Also, nursing staff or entero-stomal therapists supervise intestinal stomas in the postoperative period. Preoperative stoma education, which nurse specialists nourish, facilitates shorter hospital stays for ostomates post-surgically.