Ileostomy

An ileostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall through which a portion of the ileum, the last part of the small intestine, is brought to the skin's surface. This procedure is performed when the normal route for digestive waste through the large intestine (colon) and rectum is either blocked, diseased, or removed, necessitating an alternative route for feces to exit the body.

Types of Ileostomy

1. Loop Ileostomy:

   • In a loop ileostomy, a loop of the small intestine is brought to the surface of the abdomen, and a temporary stoma is created. The loop is then sutured to the abdominal wall, and a protective covering is placed over the stoma to collect waste. This type of ileostomy is often reversible and may be used to divert fecal flow temporarily while the colon heals.

2. End Ileostomy:

   • An end ileostomy involves bringing one end of the ileum to the surface of the abdomen to create a permanent or long-term stoma. The other end of the ileum is closed or removed, and waste exits the body through the stoma into an external pouching system.

Indications for Ileostomy

Ileostomy surgery may be indicated for various medical conditions, including:

• Inflammatory Bowel Disease (IBD):

  • Severe ulcerative colitis or Crohn's disease that is unresponsive to medical therapy, causing complications such as bowel obstruction, perforation, or toxic megacolon.

• Colorectal Cancer:

  • Surgical removal of the colon and rectum (colectomy) may be necessary for the treatment of colorectal cancer, particularly in advanced or metastatic disease.

• Diverticulitis:

  • In cases of severe diverticulitis with complications such as abscess formation, perforation, or fistula, surgical intervention may be required to remove the affected portion of the colon and create an ileostomy.

• Trauma or Injury:

  • Severe abdominal trauma or injury that necessitates surgical removal of a significant portion of the colon or rectum due to damage or non-viability.

Procedure

The creation of an ileostomy involves several steps:

1. Surgical Incision:

   • An incision is made in the abdomen, typically on the right side, below the level of the navel (umbilicus).

2. Identification and Isolation of the Ileum:

   • The ileum, the last part of the small intestine, is identified, and a segment of it is brought to the surface of the abdomen through the incision.

3. Formation of the Stoma:

   • A portion of the ileum is brought out through the abdominal wall to create a stoma. The edges of the stoma are then sutured to the skin to secure it in place.

4. Stoma Care and Education:

   • Patients receive education and training on stoma care, including how to clean the stoma, apply a protective barrier, and attach an external pouching system to collect fecal output.

Living with an Ileostomy

Adjusting to life with an ileostomy may require physical, emotional, and lifestyle adaptations. Individuals with an ileostomy may experience changes in bowel habits, body image, and self-esteem. However, with proper education, support, and self-care practices, many individuals are able to lead active and fulfilling lives with an ileostomy.

Management and Care

Managing an ileostomy involves the following:

• Stoma Care: Regular cleaning and maintenance of the stoma to prevent skin irritation, infection, and other complications.
• Dietary Modifications: Gradual reintroduction of foods and adjustment of diet to minimize gas, odor, and potential blockages.
• Fluid Intake: Adequate hydration to prevent dehydration and maintain electrolyte balance, particularly in individuals with high ileostomy output.
• Ostomy Supplies: Ensuring availability of ostomy supplies, including pouches, adhesives, and accessories, and proper fitting and comfort of the pouching system.
• Physical Activity: Engaging in regular physical activity within the limits of individual capabilities to promote overall health and well-being.
• Emotional Support: Seeking support from healthcare providers, support groups, and peers to address emotional and psychological concerns related to living with an ileostomy.

Complications

While ileostomy surgery is generally safe, complications may occur, including:

• Stoma Complications: Prolonged bleeding, retraction, stenosis (narrowing), or prolapse (protrusion) of the stoma.
• Peristomal Skin Irritation: Skin irritation, redness, or breakdown around the stoma due to leakage of stool or improper fitting of ostomy appliances.
• Obstruction or Blockage: Partial or complete blockage of the ileostomy due to food particles, adhesions, or kinks in the intestine.
• Dehydration and Electrolyte Imbalance: Loss of fluids and electrolytes through the ileostomy output, leading to dehydration, electrolyte disturbances, or metabolic complications.

Follow-Up Care

Regular follow-up appointments with healthcare providers are essential for monitoring stoma function, assessing for complications, and providing ongoing support and education. Individuals with an ileostomy should be proactive in managing their health and seeking prompt medical attention if any concerns arise.

Conclusion

Ileostomy surgery is a surgical procedure performed to divert the flow of feces and intestinal contents directly to a collection bag outside the body. It may be performed for various medical reasons, including inflammatory bowel disease, colorectal cancer, diverticulitis, or trauma. Living with an ileostomy requires physical, emotional, and lifestyle adaptations, but with proper education, support, and self-care practices, many individuals are able to lead active and fulfilling lives. Close collaboration with healthcare providers and adherence to recommended management strategies are essential for optimizing outcomes and quality of life for individuals living with an ileostomy.