A stoma is necessary whenever the trachea, bladder or bowel is closed by some process and air, urine or stool can not be transported naturally. Accordingly, a distinction is made between different stoma species.
The tracheostoma is a constant connection between the upper section of the trachea and the skin. It is created below the larynx, for the tracheotomy, the so-called tracheotomy, there are various procedures. The connection between the trachea and the skin is usually maintained by a rigid plastic tube, the tube. When the tube is removed, the opening between the trachea and the skin closes gradually.
Only with a laryngectomy, a permanent connection between skin and trachea is created, but the end of the trachea is sewn into the skin - breathing is then only possible through this opening. A tracheostoma is either applied when the larynx is narrowed by inflammation or a tumor so that not enough breathing air enters the lungs, or when a patient must be ventilated by a serious illness over a longer period of time.
For short-term ventilation, a breathing tube over the mouth or nose can be placed past the vocal folds and the ventilation can be carried out. However, in the case of continuous ventilation, the ventilation tube leads to irritation of the vocal folds and laryngeal mucosa, so that a tracheostomy is required.
Urostoma creates an artificial connection between the urinary bladder and the body surface. There are also different methods for this. Rarely, the ureters (uretero-cutaneo-stoma) or in series with an opening (TUUC, trans-uretero-uretero-cutaneo-stoma) are sewn directly into the skin, usually a piece of thin (ileum conduit) or large intestine (Colon Conduit) Removed during surgery from the intestinal structure and interposed.
The Conduit procedures have the advantage that they are still easy to perform even in patients who are very affected by their illness. As a further variant, a kind of replacement bladder (Mainz pouch I) can be made from a piece of intestine, the opening of this system is usually hidden in the navel and continental - every 4 to 6 hours, the bladder is emptied with a thin catheter.
Urostoma has an obstruction in the urinary bladder or urethra. It is usually extensive bladder or prostate carcinomas, which lead to a complete transfer of the urinary tract.
Ileostomy and colostomy
The ileostomy and the colostomy are also called artificial intestinal exit or anus praeter (naturalis). Here, too, different forms exist: a connection between the small intestine (ileum) and body surface is an ileostomy, between colon and skin a colostomy.
Depending on the location of the colostomy, a distinction is made between a cecostoma (stoma in the area of the appendix), transversostoma (for the stoma the middle section of the colon is used) or - the most common form - the sigmoidostoma in the area of the ileum. In addition, there are terminal and double-legged stoma systems: In the double-barreled form coming from the stomach intestinal section and leading to the anus are sewn into the skin, in the terminal form, the downward intestinal component is either surgically removed or closed and only coming from the stomach intestinal section in the skin is sewn in.
The plant of an ileo or colostomy is common. Currently there are about 100, 000 stoma carriers in Germany. An ileostomy is usually applied either after a bowel injury, for example in the context of a serious traffic accident, or after the complete removal of the large intestine, which is sometimes necessary after many years of course of a chronic inflammatory bowel disease. After an injury, a double-lumen ileostomy is often created, which can be relocated after some time.
A colostoma is either used to relieve the intestine in a colon tumor (usually terminal sigmoidostoma) and a bowel obstruction (usually double-barreled Zöko- or Transversostoma) or in congenital false anus of the anus (as a terminal sigmoidostoma) created.
PEG (percutaneous endoscopic gastrostomy)
Percutaneous endoscopic gastrostomy, or PEG for short, is a special case and is often used in elderly patients who are unable to absorb food and fluids on their own due to illnesses such as severe stroke or severe dementia. The PEG is then fed with food and liquid. It is often less annoying to the patient than a nasogastric tube over the mouth or nose. In PEG, a thin tube connects the stomach to the abdominal skin.