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 K-Pouch or BCIR.
This surgery turns the small intestine into an internal reservoir thus eliminating the need for
an external appliance.
Ileostomy: An opening into the ileum, part of the small intestine, from the outside of the body. An
ileostomy provides a new path for waste material to leave the body after part of the intestine has
been removed. An opening into the ileum, part of the small intestine, from the outside of the body.
An ileostomy provides a new path for waste material to leave the body after part of the intestine has
been removed.

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.

[edit]Living with an ileostomy

People with ileostomies must use an ostomy pouch to collect intestinal waste. People with
ileostomies typically use an open-end, or "drainable" pouch that is secured at the lower end
with a leakproof clip, 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, when the wafer starts to deteriorate. 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.

Some people find they must make adjustments to their diet after having an ileostomy.
Tough or high-fiber foods (including, for example, potato skins and raw vegetables) are hard
to digestin 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. 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.

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-
relatedhospital readmission to be 11%

Definition

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").

Purpose
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:

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

Description
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.

Other patients undergoing ileostomy will have only a temporary bypass of

the colon and rectum; examples are patients undergoing small bowel
resection or the creation of anileoanal anastomosis . 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.

Diagnosis/Preparation

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.

Aftercare

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.
Risks

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.

Normal results

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.

Morbidity and mortality rates

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%.
Alternatives

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 corticosteroids ; 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.

Read more: Ileostomy - procedure, tube, removal, pain, complications,

time, infection, prep, cells, types, risk, cancer, rate, Definition, Purpose,
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