Ileostomy
Encyclopedia
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.
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:
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. However, reliance on Temporary Ostomies are very over-rated. A high percentage of temporary ileostomy patients have to have a permanent ileostomy at a later stage.
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%
. 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.
Stoma (medicine)
A stoma is an opening , either natural or surgically created, which connects a portion of the body cavity to the outside environment...
constructed by bringing the end or loop of small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
(the ileum
Ileum
The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
) out onto the surface of the skin. Intestinal waste passes out of the ileostomy and is collected in an external pouching system
Ostomy pouching system
An ostomy pouching system is a medical device prosthetic that provides a means for the collection of waste from a surgically diverted biological system and the creation of a stoma...
stuck to the skin. Ileostomies are usually sited above the groin
Groin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
on the right hand side of the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
.
Ileostomies are slowly being replaced by the now preferred alternative J-Pouch
Ileo-anal pouch
The ileal pouch-anal anastomosis , also known as an ileo-anal pouch, restorative proctocolectomy, ileal-anal pullthrough, or sometimes referred to as a j-pouch, s-pouch, w-pouch or an internal pouch, is an internal reservoir; usually situated where the rectum would normally be...
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 intestineLarge intestine
The large intestine is the third-to-last part of the digestive system — — in vertebrate animals. Its function is to absorb water from the remaining indigestible food matter, and then to pass useless waste material from the body...
incapable of safely processing intestinal waste, typically because the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
has been partially or wholly removed. Diseases of the large intestine which may require surgical removal include:
- Crohn's diseaseCrohn's diseaseCrohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
- Ulcerative colitisUlcerative colitisUlcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
- Familial adenomatous polyposisFamilial adenomatous polyposisFamilial adenomatous polyposis is an inherited condition in which numerous polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when not treated....
- Total colonic Hirschprung's disease
An ileostomy may also be necessary in the treatment of colorectal cancer
Colorectal cancer
Colorectal cancer, commonly known as bowel cancer, is a cancer caused by uncontrolled cell growth , in the colon, rectum, or vermiform appendix. Colorectal cancer is clinically distinct from anal cancer, which affects the anus....
; one example is a situation where the tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
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
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
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
Ileo-anal pouch
The ileal pouch-anal anastomosis , also known as an ileo-anal pouch, restorative proctocolectomy, ileal-anal pullthrough, or sometimes referred to as a j-pouch, s-pouch, w-pouch or an internal pouch, is an internal reservoir; usually situated where the rectum would normally be...
, 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. However, reliance on Temporary Ostomies are very over-rated. A high percentage of temporary ileostomy patients have to have a permanent ileostomy at a later stage.
Living with an ileostomy
People with ileostomies must use an ostomy pouchOstomy pouching system
An ostomy pouching system is a medical device prosthetic that provides a means for the collection of waste from a surgically diverted biological system and the creation of a stoma...
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
Ostomy pouching system
An ostomy pouching system is a medical device prosthetic that provides a means for the collection of waste from a surgically diverted biological system and the creation of a stoma...
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
Dietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
foods (including, for example, potato skins, tomato skins and raw vegetables) are hard to digest
Digest
Digest can refer to any of the following:*A condensed collection or compendium of writings:**Pandects, or "The Digest", a digest of Roman law**A tax 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
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
. 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
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
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
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
. A 5-year study of patients who had ileostomy surgery in 1997 found the risk of adhesion-related
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
hospital readmission to be 11%
Other options
Since the late 1970s an increasingly popular alternative to an ileostomy has been the ileo-anal pouchIleo-anal pouch
The ileal pouch-anal anastomosis , also known as an ileo-anal pouch, restorative proctocolectomy, ileal-anal pullthrough, or sometimes referred to as a j-pouch, s-pouch, w-pouch or an internal pouch, is an internal reservoir; usually situated where the rectum would normally be...
. With such a pouch an internal reservoir is formed using the ileum
Ileum
The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
and connecting it to the anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
, after removal of the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
and rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
, thus avoiding the need for an external appliance.