c



 

An ileostomy is a surgical procedure in which the

small intestine is attached to the abdominal wall in
order to bypass the large intestine; digestive waste
then exits the body through an artificial opening
called a stoma (from the Greek word for "mouth").



In general, an ostomy is the surgical creation of an

opening from an internal structure to the outside of
the body. An ileostomy, therefore, creates a
temporary or permanent opening between the ileum
(the portion of the small intestine that empties to the
large intestine) and the abdominal wall. The colon
and/or rectum may be removed or bypassed. A
temporary ileostomy may be recommended for
patients undergoing bowel surgery (e.g., removal of a
segment of bowel), to provide the intestines with
sufficient time to heal without the stress of normal
digestion.

Chronic ulcerative colitis is an example of a medical

condition that is treated with the removal of the
large intestine. Ulcerative colitis occurs when the
body's immune system attacks the cells in the lining
of the large intestine, resulting in inflammation and
tissue damage. Patients with ulcerative colitis often
experience pain, frequent bowel movements, bloody
stools, and loss of appetite. An ileostomy is a
treatment option for patients who do not respond to
medical or dietary therapies for ulcerative colitis.

Other conditions that may be treated with an

ileostomy include:

2? bowel obstructions
2? cancer of the colon and/or rectum
 2? Crohn's disease (chronic inflammation of the
intestines)
2? congenital bowel defects
2? uncontrolled bleeding from the large intestine
2? injury to the intestinal tract

 

The United Ostomy Association estimates that

approximately 75,000 ostomy surgeries are
performed each year in the United States, and that
750,000 Americans have an ostomy. Ulcerative
colitis and Crohn's disease affect approximately one
million Americans. There is a greater incidence of
the diseases among Caucasians under the age of 30
or between the ages of 50 and 70.

  

For some patients, an ileostomy is preceded by

removal of the colon (colonectomy) or the colon and
rectum (protocolectomy). After the patient is placed
under general anesthesia, an incision approximately
8 in (20 cm) long is made down the patient's
midline, through the abdominal skin, muscle, and
other subcutaneous tissues. Once the abdominal
cavity has been opened, the colon and rectum are
isolated and removed. The anal canal is stitched
closed.

Ô    

     

 Ô
       

      

   
        

   
  
   
 

   !    
     

     

Other patients undergoing ileostomy will have only a

temporary bypass of the colon and rectum; examples
are patients undergoing "    or
the creation of an   . An
ileoanal anastomosis is a procedure in which the
surgeon forms a pouch out of tissue from the ileum
and connects it directly to the anal canal.

There are two basic types of permanent ileostomy:

conventional and continent. A conventional
ileostomy, also called a Brooke ileostomy, involves a
separate, smaller incision through the abdominal
wall skin (usually on the lower right side) to which
the cut end of the ileum is sutured. The ileum may
protrude from the skin, often as far as 2 in (5 cm).
Patients with this type of stoma are considered fecal-
incontinent, meaning they can no longer control the
emptying of wastes from the body. After a
conventional ileostomy, the patient is fitted with a
plastic bag worn over the stoma and attached to the
abdominal skin with adhesive. The ileostomy bag
collects waste as it exits from the body.

An alternative to conventional ileostomy is the

continent ileostomy. Also called a Kock ileostomy,
this procedure allows a patient to control when
waste exits the stoma. Portions of the small intestine
are used to form a pouch and valve; these are
directly attached to the abdominal wall skin to form
a stoma. Waste collects internally in the pouch and is
expelled by insertion of a soft, flexible tube through
the stoma several times a day.

#  
The patient meets with the operating physician prior
to surgery to discuss the details of the surgery and
receive instructions on pre- and post-operative care.
Directly preceding surgery, an intravenous (IV) line
is placed to administer fluid and medications, and
the patient is given a bowel prep to cleanse the bowel
and prepare it for surgery. The location where the
stoma will be placed is marked, away from bones,
abdominal folds, and scars.

Ô


Following surgery, the patient is instructed in the

care of the stoma, placement of the ileostomy bag,
and necessary changes to diet and lifestyle. Because
the large intestine (a site of fluid absorption) is no
longer a part of the patient's digestive system, fecal
matter exiting the stoma has a high water content.
The patient must therefore be diligent about his or
her fluid intake to minimize the risk of dehydration.
Visits with an enterostomal therapist (ET) or a
support group for individuals with ostomies may be
recommended to help the patient adjust to living
with a stoma. Once the ileostomy has healed, a
normal diet can usually be resumed, and the patient
can return to normal activities.

Î$

Risks associated with the ileostomy procedure

include excessive bleeding, infection, and
complications due to general anesthesia. After
surgery, some patients experience stomal
obstruction (blockage), inflammation of the ileum,
stomal prolapse (protrusion of the ileum through the
stoma), or irritation of the skin around the stoma.

%  

The physical quality of life of most patients is not

affected by an ileostomy, and with proper care most
patients can avoid major medical complications.
Patients with a permanent ileostomy, however, may
suffer emotional aftereffects and benefit from
psychotherapy.

    

Among patients who have undergone a Brooke

ileostomy, medical literature reports a 19±70% risk
of complications. Small bowel obstruction occurs in
15% of patients; 30% have problems with the stoma;
20±25% require further surgery to repair the stoma;
and 30% experience postsurgical infections. The rate
of complications is also high among patients who
have had a continent ileostomy (15±60%). The most
common complications associated with this
procedure are small bowel obstruction (7%), wound
complications (35%), and failure to restore
continence (50%). The mortality rate of both
procedures is less than 1%.

Ô  & 
Patients with mild to moderate ulcerative colitis may
be able to manage their disease with medications.
Medications that are given to treat ulcerative colitis
include enemas containing hydrocortisone or
mesalamine; oral sulfasalazine or olsalazine;
oral   ; or cyclosporine and other
drugs that affect the immune system.

A surgical alternative to ileostomy is the ileal pouch-

anal anastomosis, or ileoanal anastomosis. This
procedure, used more frequently than permanent
ileostomy in the treatment of ulcerative colitis, is
similar to a continent ileostomy in that an ileal
pouch is formed. The pouch, however, is not
attached to a stoma but to the anal canal. This
procedure allows the patient to retain fecal
continence. An ileoanal anastomosis usually requires
the placement of a temporary ileostomy for two to
three months to give the connected tissues time to
heal.
?