Jejunostoma

A Jejunostoma (Latin jejunum = "empty intestine" and Greek stoma = "mouth") denotes a surgically created connection between the jenunum (upper small intestine) and the abdominal wall for the insertion of an intestinal probe to enable the patient to be fed ethereal (artificial).

What is the jejunostomy?

This procedure is mainly performed on colorectal cancer patients. Depending on the severity of the disease, it may be necessary to surgically remove larger parts of the colon. In most cases, the creation of an artificial anus is necessary as the function of the large intestine is lost, which leads to a reduced absorption of electrolytes and water loss.

The result is mushy and thin stool and increased stool frequency. Every food intake leads to an emptying. The ileostomy is closely related to the jejunostoma when the remaining intestine is led to the abdominal skin and ends in the lower part of the ileum (small intestine). If the end of the intestine is in the higher section of the small intestine (jejunum), there is a jenunostoma.

In both cases, the doctors performed a bowel resection (removal of the large intestine). The second option is to create a connection between the anus and the small intestine after removing the large intestine without creating a permanent artificial intestinal outlet. This procedure is called ileoanal pouch or ileo-pouch-anal anastomosis (IPAA).

Function, effect & goals

Stomata are relocated end-to-end or double-barreled. With the terminal stomata, the surgeon pulls the upper bowel loop through the abdominal wall to the surface, whereby a small piece of bowel protrudes. Often the deeper section of the intestine has to be removed. A double-barreled intestinal outlet is created by pulling the intestinal loop through the abdominal skin and then cutting it open. Both intestinal openings are now on the outside and are sutured into the skin of the abdomen.

Intestinal stomata serve to relieve the remaining part of the intestine, since it no longer passes stool. They interrupt the intestinal passage and are usually only placed temporarily. A Jenustoma is always placed when larger parts of the rectum (rectum) including the anus sphincter have to be removed. Without the sphincter muscle, the patient is no longer able to control his bowel movements. Most patients find an artificial anus to be very stressful. They have to get used to it in everyday life. From a medical point of view, one can live “normally” with a jejunostoma, although this term naturally requires interpretation and the affected patients may subjectively perceive their situation to be different.

From a purely medical point of view, the large intestine is not an organ that is necessary for a patient's survival, such as the kidneys, heart or lungs. Its main purpose is to grease and thicken the stool. If this organ has to be partially removed, there is no risk of reduced life expectancy. In the first few months after the operation in particular, the patients' everyday lives change enormously, as they have to get used to their artificial anus and adjust their lifestyle accordingly. Many patients take a long time to get used to their changed digestive system, while others cannot come to terms with the artificial anus.

How stressful these restrictions are perceived also always depends on the individual life situation. From the patient's point of view, an artificial anus is always a greater burden than a large intestine that has only been shortened. This is a "short circuit" between the small intestine and anus. There is no health risk, the stool becomes more fluid because the thickening process is absent. If this short circuit is not possible, an artificial anus (Jejenustoma) is placed. The small intestine ends in a small opening in the skin of the abdomen.

A stoma is induced in the following diseases: Crohn's disease and ulcerative colitis (chronic inflammation of the intestine), 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 missing sphincter function, intestinal perforation , postoperative complications, and congenital colon polyps. With the artificial anus, a loop of intestine protrudes from the abdominal cavity.

A plate is placed around the exit site to protect the affected skin. This is where the ostomy bag is attached, which catches the stool. A distinction is made between one and two-part systems. The one-piece system firmly connects the base plate and the bag; they can only be changed together. The two-part system keeps the plate and bag separate from one another, which can also be exchanged independently of one another. The advantage of this system is that the base plate on the skin does not have to be changed every day, but remains there for a few days.

The aim of the jejunostomy is to bypass the natural digestive process, as the stool is not diverted through the anus, but is diverted to the artificial anus through the abdominal wall. Through this procedure, parts of the intestine are "shut down" and the healthy part is preserved. After the procedure, nutritional therapy is often carried out in order to adapt the organism to the changed digestive situation. In order to bridge this habituation phase, nutritional therapy supplies the patient with important nutrients by means of infusions. It compensates for the loss of nutrients in minerals such as potassium, sodium and magnesium and the loss of water.

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Risks, side effects & dangers

Around 100,000 people in Germany have a permanent or temporary stoma. From a medical point of view, there are no health restrictions because the large intestine is not an essential organ. Nevertheless, there is a change that takes getting used to due to the "diverted" bowel movements. Many patients would cope with this change well, a large part is a matter of the head, according to the doctors.

Nevertheless, many sufferers report significant side effects that are not only medical but also social in nature. Many young people under the age of thirty have to live with an artificial anus after their colon removal. In most cases, the organ was removed due to degenerate polyps. These patients complain that their social contacts are restricted and that they are no longer able to have a “normal” relationship, especially in sexual terms. Activities with friends are very limited due to the changed nutritional situation. The biggest side effect of the stoma, however, is chronic soreness of the skin areas directly affected by the intestinal stoma.

Wound complications arise in particular when the base plate is not cut correctly and the skin area cannot protect against the aggressive stool. There are various pastes and creams available for wound care; cleaning is carried out using fleece compresses and pH-neutral soap. Many patients describe wound care as complicated, and several plaster or bandage changes per day are necessary if the affected areas are wet.

A large number of ostomy patients have found that specialist staff, for example ostomy nurses in hospitals, are overwhelmed with wound care due to lack of time. You have the option of having expert wound care in intestinal centers or by expert nursing staff in the outpatient department through your family doctor. In some cases there are serious post-operative complications such as infections that require a longer stay in hospital.