ileostomy

1. Surgical construction of an artificial excretory opening through the abdominal wall into the ileum.
2. The opening created by such a surgical procedure.

[ILE(UM) + -STOMY.]

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

Demographics

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.

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.

An ileostomy can be placed in different sites on the abdomen (A). Once the incision is made, the ileum is pulled through the incision (B), and a rod is placed under the loop. The loop is cut open, one side is stitched to the abdomen (C). The portion of intestine is flipped open to expose the interior surface (D), and the opposite side is stitched in place (E). (Illustration by GGS Inc.)

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 an ileoanal 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.

Resources

Books

"Inflammatory Bowel Diseases: Ulcerative Colitis." In TheMerck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Pemberton, John H., and Sidney F. Phillips. "Ileostomy and Its Alternatives" (Chapter 105). In Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 7th ed. Philadelphia: Elsevier Science, 2002.

Rolandelli, Rolando H., and Joel J. Roslyn. "Colon and Rectum," (Chapter 46), In Sabiston Textbook of Surgery. Philadelphia: W. B. Saunders Company, 2001.

Periodicals

Allison, Stephen, and Marvin L. Corman. "Intestinal Stomas in Crohn's Disease." Surgical Clinics of North America 81, no. 1 (February 1, 2001): 185-95.

Organizations

Crohn's and Colitis Foundation of America. 386 Park Ave. S., 17th Floor, New York, NY 10016. (800) 932-2423. www.ccfa.org.

United Ostomy Association, Inc. 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. (800) 826-0826. www.uoa.org.

Other

Hurst, Roger D. "Surgical Treatment of Ulcerative Colitis." [cited May 1, 2003]. www.ccfa.org/medcentral/library/surgery/ucsurg.htm.

— Stephanie Dionne Sherk

Surgical formation of an opening of the ileum on the abdominal wall, performed to treat severe ulcerative colitis; see gastro-intestinal tract.

An artificial opening (stoma) created in the small intestine (ileum) and brought to the surface of the abdomen for the purpose of evacuating feces.

• urinary i. — use of a segment of the ileum as a stoma for the diversion of urinary flow from the ureters. See also ileal conduit.

This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (July 2007)

Intervention: Ileostomy
ICD-10 code:
ICD-9 code:	46.2
MeSH	D007081
Other codes:

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.

Contents 1 Reasons for having an ileostomy 2 Living with an ileostomy 3 Other options 4 See also 5 References

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.

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 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. 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-related hospital readmission to be 11% ^[1]

Other options

Since the late 1970's an increasingly popular alternative to an ileostomy has been the ileo-anal pouch. 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.

See also

• Colostomy

References

Cited

1. ^ Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM; Surgical and Clinical Adhesions Research (SCAR) Group. (2005). "The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures.". Colorectal Dis. 7 (6): 551-558. doi:10.1111/j.1463-1318.2005.00857.x. PMID 16232234. http://www3.interscience.wiley.com/journal/118740522/abstract?CRETRY=1&SRETRY=0. Retrieved 2009-03-05. 

Uncited

• IA - The Ileostomy and Internal Pouch Support Group. The UK's premier support group.
• United Ostomy Associations of America
• Ileostomy Guide by the American Cancer Society

v • d • e Digestive system surgical and other procedures (ICD-9-CM V3 42-54) Digestive tract Upper GI tract SGs/Esophagus Sialography · Esophagectomy Stomach Gastrostomy (Percutaneous endoscopic gastrostomy) · Gastrectomy (Billroth I, Billroth II, Roux-en-Y) · Gastric bypass surgery · Gastroenterostomy · Hill repair · Nissen fundoplication · Gastropexy · Sleeve gastrectomy Imaging Endoscopy: Esophagogastroduodenoscopy Upper gastrointestinal series Lower GI tract Small bowel Duodenal switch · Jejunoileal bypass · Jejunostomy · Ileostomy · Partial ileal bypass surgery Large bowel Colectomy · Colostomy · Appendicectomy · Hartmann's operation Rectum Lower anterior resection · Abdominoperineal resection Anus Anal sphincterotomy · Lateral internal sphincterotomy Imaging Endoscopy: Colonoscopy (Virtual) · Proctoscopy · Sigmoidoscopy · Enteroscopy · Capsule endoscopy Transrectal ultrasonography · Enteroclysis · Small bowel follow-through · Abdominal ultrasonography · Lower gastrointestinal series Accessory Liver Hepatectomy · Liver transplantation · Artificial extracorporeal liver support (Liver dialysis, Bioartificial liver devices) Gallbladder, bile duct Cholangiography (Endoscopic retrograde cholangiopancreatography, Percutaneous transhepatic cholangiography, Magnetic resonance cholangiopancreatography) · Cholecystectomy · Cholecystography · ESWL · HIDA scan Pancreas Pancreatectomy · Pancreaticoduodenectomy · Pancreas transplantation · Puestow procedure · Frey's procedure Peritoneum Paracentesis · Intraperitoneal injection Hernia Herniorrhaphy · MacEwen's operation Other Laparotomy digestive system navs: anat of tract,glands,perit/layers/physio/dev, noncongen/congen/congen of d+w/neoplasia, symptoms+signs/eponymous, proc

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)