Ileostomy
An ileostomy is a surgical procedure that involves creating an opening in the abdomen, known as a stoma, from the last segment of the small intestine (ileum). This procedure can be either permanent, referred to as an end ileostomy, or temporary, known as a loop ileostomy. It is often performed to address conditions affecting the ileum or colon, such as cancers of the colorectal region, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, or situations where the bowel is obstructed or nonfunctional.
The ileostomy allows for the diversion of digested material, facilitating healing of the remaining bowel, and can enable future reattachment if healthy segments are available. Post-surgery, patients must adjust to maintaining their ileostomy, which includes learning to manage the collection bag and being mindful of their diet and hydration. While ileostomies are not curative for conditions like cancer, they can significantly improve quality of life by restoring a degree of bowel function. However, patients may face emotional challenges related to body image and the routine of dealing with an ostomy. Understanding the risks, care requirements, and emotional implications is essential for anyone considering or undergoing this procedure.
On this Page
Subject Terms
Ileostomy
ALSO KNOWN AS: End ileostomy, loop ileostomy, separated loop ileostomy, continent ileostomy
DEFINITION: An ileostomy is a procedure that creates an opening in the abdomen (stoma) from a segment of the latter portion of the small bowel (ileum). An ileostomy can be permanent (end ileostomy) or temporary (loop ileostomy).
Cancers treated: Colorectal and small bowel cancer; metastatic pelvic cancer, including vaginal, cervical, ovarian, and prostate cancers
Why performed: The ileum may sometimes become diseased or cause bowel obstruction, bleeding, or nutrient malabsorption symptoms. Potentially life-threatening or premalignant conditions such as severe inflammatory bowel disease involving the ileum and colon (Crohn's disease, ulcerative colitis) are also managed with the use of ileostomy. Because the ileum absorbs many essential nutrients relative to the rest of the small bowel, preservation of disease-free regions is paramount. An ileostomy is performed primarily to divert digested material for excretion in cases where the colon or rectum is diseased or otherwise unusable. It also permits healing of the remaining but usable colon, which can be used later to establish continuity between the small and large bowels. This is also done after two bowel ends are newly rejoined (anastomosis) to allow the bowel to rest and expedite healing. The ileostomy is located before the anastomosis to prevent digested material from stimulating the joined ends from unnecessary contractions.
Patient preparation: Surgical risk assessment includes a general physical examination, medication review and revision, electrocardiography (EKG) and chest X-ray, and pulmonary function tests as needed. Other considerations include ensuring the patient is adequately nourished and hydrated beforehand. Bowel preparation includes gradually decreasing food and liquid intake, and enemas are carried out at least twenty-four hours before the procedure.
The decision to undergo the procedure should be accompanied by active patient participation. If reattachment to the distal bowel is impossible, the patient must be thoroughly briefed regarding the care of and implications of a permanent ileostomy. If the procedure is agreeable to the patient, then the position of the stoma is discussed and marked on the patient’s abdomen before the procedure.
Steps of the procedure: After the patient is positioned and the surgical site is sterilized, a mid-abdominal incision is made and carried down to the abdominal cavity. The length of the small and large bowel is examined for viable and nonviable regions. Any diseased sections are excised, with the undiseased ends reattached. Any additional abdominal cavity procedure, such as lymph node dissection and resection, is carried out.
The construction of the ileostomy will depend on the severity of the disease (the presence of a disease-free colon for reattachment in a separate procedure). A permanent end ileostomy is constructed by dividing the remaining ileum from the colon, preserving as much bowel as possible. Both ends are closed with staples or sutures. The thin membrane containing the bowel’s blood vessels (mesentery) at the proximal ileal end is cut to allow manipulation. The vessels directly supplying it are preserved. Another abdominal incision is made over the previously marked area, through which six centimeters of ileum is pulled. The stapled end is cut, and a spigot is fashioned by suturing the ileum onto the skin at three points. This prevents the fluid and electrolyte imbalance of ileostomy dysfunction caused by partial stoma obstruction.
A temporary loop ileostomy is constructed similarly to an end ileostomy, except that both ends of the ileum are used, with the distal end nonfunctional in excretion. The mesentery interruption is minimal because both ends must be supplied adequately with blood.
After the procedure: The patient can recover consciousness in a postanesthesia care unit before going to the surgical ward. Recovery time can reach ten to twelve days, with the resumption of normal activity in four to eight weeks. Maintenance of the ileostomy involves becoming familiar with frequently changing the appliance's parts, such as the skin barrier and the ileostomy bag. With the absence of the colon as a water-reabsorbing and storage apparatus for digested food, the patient must empty the collection bag frequently and be more aware of the amount and type of food and drink consumed, especially during exercise and hot weather.
Risks: The risks of bleeding, impaired healing, and infections are always present. Meticulous adherence to surgical techniques prevents most of these complications. Long-term risks for the duration of the ileostomy include obstruction from food particles or bowel adhesions, fistulas, infection, and dehydration from increased ileostomy fluid output.
Results: An ileostomy is not directly curative for cancer, but it is a helpful procedure in restoring the patient’s continence and a semblance of normal bowel function later through the anastomosis of the ileum to the colon or rectum. While the position of an ileostomy allows for easy cleaning and draining of the ileostomy appliance and does not interfere significantly with daily routines and activities, one of the most critical patient considerations to be made is that of self-image after ileostomy.
Bibliography
Abeloff, Martin D. Abeloff’s Clinical Oncology. 6h ed., Elsevier, 2020.
Bernstein, Charles N. Inflammatory Bowel Disease Yearbook 2004. Remedica, 2004.
De Manzini, Nicolò. Rectal Cancer Strategy and Surgical Techniques. Springer, 2012.
Gislason, Stephen J. Food and Digestive Disorders: Irritable Bowel Syndrome, Crohn’s Disease, Celiac Disease, Ulcerative Colitis, Ulcers, Reflux and Motility Disorders. Environmed Research, 2003.
"Ileostomy." Cleveland Clinic, 15 Apr. 2024, my.clevelandclinic.org/health/procedures/21726-ileostomy. Accessed 20 June 2024.
Molloy, Richard G. Colorectal Surgery. 2nd ed., Oxford University Press, 2021.
Rajaretnam, N., and Lieske B. "Ileostomy." National Library of Medicine, 24 July 2023, www.ncbi.nlm.nih.gov/books/NBK519003. Accessed 20 June 2024.
"What Is an Ileostomy?" American Cancer Society, 2019, www.cancer.org/cancer/managing-cancer/treatment-types/surgery/ostomies/ileostomy/what-is-ileostomy.html. Accessed 20 June 2024.
Williams, Simon J. Medicine and the Body. Sage, 2003.
Yeo, Charles J. Shackelford's Surgery of the Alimentary Tract. 8th ed., Elsevier, 2019.