Ileostomy

Definition

An ileostomy is an opening in your belly wall that is made during surgery. The word "ileostomy" comes from the words "ileum" and "stoma." Your ileum is the lowest part of your small intestine. "Stoma" means "opening." Your ileum will pass through a stoma after your surgery.

Alternative Names

Enterostomy

Description

Ileostomies are used to deliver waste out of the body when the colon or rectum are not working properly.

Before you have surgery to create an ileostomy, you may have surgery to remove all of your colon and rectum, or just part of your small intestine.

See also:

• Total proctolectomy with ileostomy
• Total abdominal colectomy
• Small bowel resection

You may use your ileostomy for only a short time, or it may be created for long-term use. When it is long-term, it is usually because all of your large intestine and rectum have been removed.

To create the ileostomy, the surgeon makes a small incision (cut) in the wall of your belly for the stoma. Then the part of your small intestine that is farthest from your stomach is brought up and used as the stoma.

When you look at your stoma, you are actually looking at the lining of your intestine. It looks a lot like the inside of your cheek.

Sometimes ileostomies are made as the first step in forming an ileal anal reservoir (called a J-pouch).

Why the Procedure Is Performed

Ileostomy surgery is done when problems with your large intestine cannot be treated without surgery.

Many different problems may lead to the need for this surgery. Some are:

• Inflammatory bowel disease (ulcerative colitis or Crohn's disease), the most common reason
• Colon or rectal cancer
• A condition called familial polyposis
• Birth defects that involve your intestines
• An accident that damages your intestines or another intestinal emergency

Your ileostomy may be short-term. If you have surgery on part of your large intestine, your doctor may want the rest of the large intestine or your small intestine to rest for a while. You will use the ileostomy while you recover from this surgery. When you do not need it anymore, you will have another surgery to reattach the ends of the small intestine, and you will no longer need the ileostomy.

When your ileostomy is short-term, it usually means all of your large intestine was removed but you still have at least part of your rectum.

Risks

Talk with your doctor about these possible risks and complications.

Risks for any surgery are:

• Wound (incision) infection
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke

Risks for this surgery are:

• Bleeding inside your belly
• Damage to nearby organs
• Infection, including in the lungs, urinary tract, or belly
• Scar tissue may form in your belly and cause blockage in your intestines.
• Your wound may break open.
• Poor healing of your wound in your perineum (if your rectum was removed)
• You may not be able to absorb needed nutrients from food.
• You may get dehydrated (not have enough fluid in your body) if there is a lot of watery drainage from your ileostomy.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

Talk with your doctor or nurse about these things before you have surgery:

• Intimacy and sexuality
• Sports
• Work
• Pregnancy

During the 2 weeks before your surgery:

• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• Eat high fiber foods and drink 6 to 8 glasses of water every day.

The day before your surgery:

• Eat a light breakfast and lunch.
• You may be asked to drink only clear liquids such as broth, clear juice, and water after noontime.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
• Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions for this.

On the day of your surgery:

• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will be in the hospital for 3 to 7 days. You may have to stay longer if your ileostomy was an emergency operation.

You may be able to suck on ice chips on the same day as your surgery to ease your thirst. By the next day, you will probably be allowed to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowels begins to work again. You may be eating again 2 days after your surgery.

Outlook (Prognosis)

Most people who have an ileostomy are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

If you have a chronic condition, such as Crohn's disease or ulcerative colitis, you may need ongoing medical treatment.

References

Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 110.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Khatri VP, Asensio JA, eds. Subtotal colectomy/panproctocolectomy and j-pouch reconstruction. Operative Surgery Manual. 1st Ed. Philadelphia, Pa: Saunders; 2003:chap 35.

Scriver G, Hyman N. Ileostomy construction. Operative Techniques in General Surgery. 2007;9(1): 43-49.