Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.

Uses

Ileostomies are necessary where injury or a surgical response to disease has meant the large intestine cannot safely process waste, typically because the colon and rectum have been partially or wholly removed.

Diseases of the large intestine which may require surgical removal include Crohn's disease, ulcerative colitis, familial adenomatous polyposis, and total colonic Hirschsprung's disease. An ileostomy may also be necessary in the treatment of colorectal cancer or ovarian cancer. One example is a situation where the cancer tumor is causing a blockage (obstruction). 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 internal/external anal sphincter function.

In an end ileostomy, the end of the ileum is everted (turned inside out) to create a spout and the edges are sutured under the skin to anchor the ileum in place. Permanent ileostomies are usually done this way. An end ileostomy may be temporary, notably if some of the large intestine was removed and the bowel or overall health is not considered amenable to tolerating further surgery, such as an anastomosis to rejoin the small and large intestines.

Duration

In a temporary or loop ileostomy, a loop of the ileum is surgically brought through the skin creating a stoma, but keeping the lower portion of the ileum for future reattachment in cases where the entire colon and rectum are not removed but need time to heal. Temporary ileostomies are also often made as the first stage in surgical construction of an ileo-anal pouch, so fecal material does not enter the newly made pouch until it heals and has been tested for leaks—usually requiring a period of eight to ten weeks. When healing is complete the temporary ileostomy 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

thumb|Ileostomy with bag (pouch).

People with ileostomies must use an ostomy pouch to collect intestinal waste. People with ileostomies typically use an open-ended (referred to as a "drainable") one- or two-piece pouch that is secured at the lower end with a leakproof clip, or velcro fastener. The alternative is the closed-end pouch that must be thrown away when full. Ordinarily, the pouch must be emptied five to eight times a day. If the bag stays empty for more than four to six hours, individuals should contact their healthcare provider, as this may indicate intestinal blockage.

Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the pouch becomes too full. It is necessary to measure the stoma regularly as it changes shape after the initial surgery. The stomal- or colorectal-nurse does this initially for a patient and advises them on the exact size required for the pouch's opening. Changes in size and shape can indicate a problem and may signal a need to call a healthcare provider. Many foods can change the color of the intestinal output, causing alarm; beetroot, for instance, produces a red output that may appear to be blood.

After having ileostomies, people may continue to take baths and showers and have an active lifestyle. These and other topics are important to discuss with healthcare providers.

Complications can include kidney stones, gallstones, and post-surgical adhesions.

Other options

In some patients with Crohn's disease, a procedure called an ileoanal anastomosis is done if the disease affects the entire colon and rectum, but leaves the anus unaffected. In this procedure, the entire large intestine and rectum is surgically removed, and the ileum is then stitched to the anus to allow fecal matter to go through the ileum just as it did when the patient had a large intestine. This procedure requires a temporary loop ileostomy to allow the anastomosis to heal. With lifestyle adjustments, those who have had this procedure for their Crohn's disease can resume normal bowel movements without artificial appliances. However, there is always the possibility of disease relapse, as Crohn's can affect mouth to anus.

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Since the late 1970s, an increasingly popular alternative to an ileostomy has been the Barnett continent intestinal reservoir (or BCIR). The formation of this pouch (made possible through a procedure first pioneered by Nils Kock in 1969), involves the creation of an internal reservoir which is formed using the ileum and connecting it through the abdominal wall in a very similar fashion to a standard "Brooke" ileostomy. The BCIR procedure should not be confused with a J-pouch, which is also an ileal reservoir, but is connected directly to the anus—after removal of the colon and rectum—avoiding the need for subsequent use of external appliances.

Barnett continent intestinal reservoir

The Barnett continent intestinal reservoir (BCIR) is a type of an appliance-free intestinal ostomy. The BCIR was a modified Kock pouch procedure pioneered by William O. Barnett. It is a surgically created pouch, or reservoir, on the inside of the abdomen, made from the last part of the small intestine (the ileum),

References

  • Ileostomy-surgery website
  • American Society of Colon & Rectal Surgeons; ASCRS website
  • United Ostomy Associations of America; Ostomy Association website (visited: May 23, 2018)