Ileostomy

Ileostomy
Intervention
Ileostomy.
ICD-9-CM	46.2
MeSH	D007081

An ileostomy is a surgical opening constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin. Intestinal waste passes out of the ileostomy and is collected in an external pouching system stuck to the skin. Ileostomies are usually sited above the groin on the right hand side of the abdomen.

Ileostomies are slowly being replaced by the now preferred alternative J-Pouch or BCIR. This surgery turns the small intestine into an internal reservoir thus eliminating the need for an external appliance.

Reasons for having an ileostomy

Ileostomies are necessary where disease or injury has rendered the large intestine incapable of safely processing intestinal waste, typically because the colon has been partially or wholly removed. Diseases of the large intestine which may require surgical removal include:

• Crohn's disease
• Ulcerative colitis
• Familial adenomatous polyposis
• Total colonic Hirschprung's disease

An ileostomy may also be necessary in the treatment of colorectal cancer; one example is a situation where the tumor is causing a blockage. In such a case the ileostomy may be temporary, as the common surgical procedure for colorectal cancer is to reconnect the remaining sections of colon or rectum following removal of the tumor provided that enough of the rectum remains intact to preserve sphincter function. In a temporary ileostomy, a loop of the small intestine is brought through the skin, and the colon and rectum are not removed. Temporary ileostomies are also often made as the first stage in surgical construction of an ileo-anal pouch, so fecal material doesn't enter the newly-made pouch until it heals and has been tested for leaks – usually a period of eight to ten weeks. The temporary ostomy is then "taken down" or reversed by surgically repairing the loop of intestine which made the temporary stoma and closing the skin incision.

Living with an ileostomy

Ileostomy with bag (pouch).

People with ileostomies must use an ostomy pouch to collect intestinal waste. People with ileostomies typically use an open-end, or "drainable" one or two-piece pouch that is secured at the lower end with a leakproof clip, or velcro fastening, rather than a closed-end pouch which must be thrown away when full. Ordinarily the pouch must be emptied several times a day (many ostomates find it convenient to do this whenever they make a trip to the bathroom to urinate) and changed every 2–5 days for two piece pouches when the base wafer begins to deteriorate,changed every twenty-four hours for one piece pouches. Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the wearer allows the pouch to become too full. It is essential to have the stoma measured regularly as it changes in shape after the initial surgery. The Stomal or Colorectal nurse should be able to do this for a patient and advise on the exact size required for the bag(pouch)'s opening.

Some people find they must make adjustments to their diet after having an ileostomy. Tough or high-fiber foods (including, for example, potato skins, tomato skins and raw vegetables) are hard to digest in the small intestine and may cause blockages or discomfort when passing through the stoma. Chewing food thoroughly can help to minimize such problems. Some people also find that certain foods cause annoying gas or diarrhea. Many foods can change the colour of the output, causing alarm - Beetroot produces a red output that may appear to be blood. This is a discoluration only. Nevertheless, people who have an ileostomy as treatment for inflammatory bowel disease typically find they can enjoy a more "normal" diet than they could before surgery. Correct dietary advice is essential in combination with the patient's gastroenterologist and hospital approved dietician. Supplementary foods may be prescribed and liquid intake and output monitored to correct and control output. If output does contain blood at any time, an ileostomate is advised to visit the local A&E.

Other complications can include kidney stones, gallstones, and post-surgical adhesions. A 5-year study of patients who had ileostomy surgery in 1997 found the risk of adhesion-related hospital readmission to be 11%

Other options

Since the late 1970s an increasingly popular alternative to an ileostomy has been the ileo-anal pouch. With such a pouch an internal reservoir is formed using the ileum and connecting it to the anus, after removal of the colon and rectum, thus avoiding the need for an external appliance.

See also

• Colostomy

References

Inline citations

General references

• IA - The Ileostomy and Internal Pouch Support Group. The UK's premier support group.
• United Ostomy Associations of America
• Ileostomy Guide by the American Cancer Society
• Ostomy NSW, an Australian member-based ostomy association
• Worldwide information portal on/to all aspects of ostomy life. Mutual Links to 80 International Ostomy Associations, 100 Manufacturers, forums etc.