An enterostomy is a surgical procedure that creates an opening, known as a stoma, from a part of the intestine to the surface of the abdomen. This opening allows bodily waste to be rerouted and collected outside the body when the normal digestive tract cannot function as intended. The procedure can be a temporary measure or a permanent alteration, depending on the underlying medical condition.
Medical Reasons for an Enterostomy
Various medical conditions affecting the intestines necessitate an enterostomy. Colorectal cancer is a frequent reason, with more than 75% of all stomas created as part of its treatment. Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, also necessitate this surgery when sections of the bowel are severely diseased or require removal.
Other conditions include diverticulitis, which involves inflamed pouches in the colon, and bowel obstructions caused by issues like adhesions, tumors, or volvulus (twisting of the bowel). Severe abdominal trauma can also lead to the need for an enterostomy to allow the damaged bowel to heal or to divert waste. A temporary enterostomy allows a portion of the bowel to rest and heal, while a permanent one is created when the affected part of the bowel or rectum cannot be reconnected.
Types of Enterostomies
Enterostomies are categorized by the part of the intestine brought to the abdominal surface. The two most common types are colostomies and ileostomies. A colostomy involves creating a stoma from the large intestine, often located on the left side of the abdomen. The consistency of stool from a colostomy can range from liquid to formed, resembling typical bowel movements, because the remaining colon can still absorb water.
An ileostomy, conversely, involves bringing a section of the small intestine to the abdominal surface, usually on the lower right side. Since the large intestine’s water absorption function is bypassed, ileostomy output is more liquid and continuous. This difference in output consistency has practical implications for pouch management and hydration, as ileostomy output can be more irritating to the skin due to digestive enzymes.
The Enterostomy Procedure and Recovery
Enterostomy surgery can be performed using either an open approach (a single, longer incision) or a minimally invasive laparoscopic technique (several smaller incisions). Regardless of the method, the surgeon creates the stoma by bringing a section of the intestine through the abdominal wall and attaching it to the skin. The stoma protrudes slightly from the skin (1.5 to 3.5 cm) for efficient waste collection into an appliance.
Following the procedure, patients remain in the hospital for three to ten days while their recovery is monitored. During this initial period, the stoma will appear swollen and bright red, which is a normal part of the healing process. A specialized ostomy nurse teaches individuals how to care for their new stoma and manage the external pouching system. The stoma’s output may initially be erratic before settling into a more regular pattern over the following weeks.
Living with an Enterostomy
Adapting to life with an enterostomy involves managing the ostomy appliance, also known as a pouching system. This system consists of a skin barrier that adheres to the abdomen around the stoma and a collection pouch. Patients empty the pouch multiple times a day when it is about one-third full and change the entire system regularly, every few days, depending on individual needs and output.
Proper stoma and peristomal skin care are important to prevent irritation and maintain skin health. The skin around the stoma should be cleaned gently with water during each pouch change, avoiding harsh soaps or wipes that could interfere with appliance adhesion. Applying a skin barrier paste or ring can help create a better seal and protect the skin from corrosive output, especially with an ileostomy.
Dietary adjustments are necessary to manage output and avoid complications. Individuals with an ileostomy, in particular, need to maintain good hydration by drinking at least 2 liters of fluid daily to counteract fluid loss. Chewing food thoroughly is also important to prevent food blockages, which can occur with fibrous foods like nuts, popcorn, or raw fruit skins. Gradually reintroducing foods and observing their effects on gas or stool consistency helps in establishing a comfortable diet. Most people can resume a wide range of physical activities and wear regular clothing, though some may opt for supportive garments or stoma guards during certain activities.
Potential Complications
While enterostomy surgery is safe, several potential complications can arise. Peristomal skin irritation is frequently caused by leakage of stool around the stoma or an improperly fitting appliance. This irritation can manifest as contact dermatitis and may require adjustments to the pouching system or the use of protective skin products.
Food blockages can occur, particularly with ileostomies, if undigested fibrous foods accumulate and obstruct the narrow opening. Symptoms include decreased or absent output, abdominal pain, and swelling of the stoma or abdomen, necessitating medical attention. Dehydration and electrolyte imbalances, such as low potassium or sodium, occur with ileostomies due to continuous liquid output and reduced water absorption by the colon.
Another potential complication is a parastomal hernia, which is a bulge around the stoma where a portion of the intestine protrudes through the abdominal wall. While some are asymptomatic, these hernias can cause discomfort, difficulty with pouching, or lead to bowel obstruction. Any concerns about these or other issues should prompt immediate contact with a healthcare provider or ostomy nurse for assessment and management.