An ileostomy is a surgical procedure that creates an opening from a part of the small intestine, the ileum, to the outside of the body. This opening allows digested waste to exit the body, bypassing the large intestine and anus. The procedure is performed when the colon or rectum cannot properly process waste due to disease, injury, or other complications.
Basic Understanding of Ileostomy
An ileostomy reroutes the digestive tract, creating an alternative pathway for waste elimination. A surgeon brings a section of the ileum through an opening in the abdominal wall. This newly created opening is called a stoma, which appears as a reddish, moist piece of intestine on the abdomen. A pouching system, also known as an ileostomy bag, is then attached to the stoma to collect the waste.
The primary purpose of an ileostomy is to divert stool away from a diseased, damaged, or healing portion of the bowel. This allows the affected part of the digestive tract to rest and recover, or it provides a permanent solution when the large intestine must be removed. The output from an ileostomy is typically loose or porridge-like, as the large bowel is responsible for absorbing water and solidifying stool.
Long-Term Medical Conditions
Several chronic medical conditions can necessitate an ileostomy when other treatments are ineffective. Inflammatory Bowel Disease (IBD), such as Crohn’s disease and ulcerative colitis, is a common reason. For ulcerative colitis, an ileostomy may be performed if medication fails to manage severe inflammation, or if complications like toxic megacolon arise. Surgical removal of the colon, often followed by an ileostomy, can cure ulcerative colitis.
Crohn’s disease, which can affect any part of the digestive tract, might necessitate an ileostomy due to complications such as strictures, fistulas, or when medical therapies are unsuccessful. While surgery does not cure Crohn’s disease, it can provide symptom relief. Familial Adenomatous Polyposis (FAP) is a genetic condition that frequently leads to an ileostomy. FAP causes numerous polyps to develop in the colon and rectum, with a high risk of becoming cancerous if the colon is not removed.
Certain colorectal cancers also require an ileostomy, especially when large sections of the bowel or rectum are removed. An ileostomy may be created to allow the remaining bowel to heal after cancer surgery, or if reconnection is not possible or safe. Less common chronic conditions, such as severe diverticulitis complications or severe motility disorders, can also lead to an ileostomy if they cause extensive damage or blockages.
Sudden Medical Emergencies
An ileostomy can become a life-saving measure in acute medical situations. A bowel obstruction, a blockage preventing waste passage, may require an ileostomy if non-surgical means fail. These blockages can result from tumors, scarring, or other conditions. Diverting the fecal stream through an ileostomy relieves pressure and prevents further damage.
Bowel perforation, a hole in the intestinal wall, is another urgent reason. Leaking intestinal contents into the abdominal cavity can cause severe infection and inflammation, necessitating immediate surgical diversion and repair. Severe trauma to the abdomen, such as accidents or injuries, can also damage the intestines. In such cases, an ileostomy diverts waste and allows the injured bowel to heal.
Acute complications of IBD, like toxic megacolon, where the colon becomes severely dilated and risks rupture, or uncontrollable bleeding, often require emergency ileostomy. In these critical scenarios, an ileostomy provides immediate relief and stabilizes the patient’s condition, allowing for further treatment or eventual reversal.
Temporary or Permanent
An ileostomy can be temporary or permanent, depending on the medical reason and the patient’s long-term prognosis. A temporary ileostomy is often created to allow a diseased or injured bowel to heal. This is common after major surgeries, such as for colorectal cancer or severe inflammation, where the surgeon wants to protect a newly created connection in the bowel from stool flow. Once the bowel has healed, within weeks to months, a reversal surgery can reconnect the intestines for normal bowel function.
A permanent ileostomy is necessary when a significant portion of the large intestine or rectum has been removed, making reconnection impossible or too risky. This occurs in cases of widespread cancer, extensive damage from IBD, or familial adenomatous polyposis where the entire colon and rectum are removed to prevent cancer. In these situations, the ileostomy becomes the long-term method for waste elimination, and the individual will wear a pouch for life. The decision between a temporary and permanent ileostomy is made by the surgical team based on the specific medical needs and potential for recovery.