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Small intestine

The ileum is the last part of the small intestine, or small bowel, which connects to the large bowel. Treatment for some bowel diseases requires interruption or removal of part or all of the bowel. If this is done, a new way for stool to leave the body must be created. When a surgeon creates an artificial opening in the bowel for stool to pass through, this is called an ostomy. If the opening is created in the ileum, the procedure is called an ileostomy.

In most cases, the artificial opening in the ileum is connected to the abdominal wall. The stool can then drain out of the body in an opening through the skin. The opening of the skin in the abdominal wall is called a stoma. An ileostomy may be temporary or permanent.

This procedure may be done in different ways. A "traditional" procedure is performed when the bowel contents are allowed to drain continuously into a bag. The person has no control over the drainage. A "continent" procedure is done in some cases. In this case, a special pouch is created. This pouch connects to the abdominal wall, but no external bag is needed. The bowel contents do not drain constantly. Instead, the person empties the pouch two to four times a day by inserting a special catheter, or tube.

Who is a candidate for the procedure?
This procedure may be performed for many reasons. Examples of conditions that may require an ileostomy include:
  • bowel infections
  • conditions that cause severe bowel inflammation, such as Crohn's disease
  • bowel injuries
  • bowel blockages
  • cancer
How is the procedure performed?
If the procedure is planned, the bowel will be prepared. A liquid diet will be used for several days before surgery, and bowel cleansers will be given. Antibiotics may be given to kill bacteria in the bowel. Bowel preparation can decrease the risk of infection, but it may not be possible in emergency cases.

The abdomen is marked for placement of the stoma before surgery. When possible, the stoma is placed in the most convenient place for the person. Usually, the stoma is placed in the right lower part of the abdomen.

This procedure is usually done using general anaesthesia. This means the person will be asleep and not feel any pain. People are hooked up to a ventilator, or artificial breathing machine, during the surgery. The machine is turned off after the surgery, once the person can breath independently.

During a traditional procedure, the surgeon removes or interrupts the diseased bowel. A part of the ileum is then brought out through the skin. The bowel opening is attached to the skin of the abdomen with stitches. The opening, or stoma, is red or pink, oval, and shiny. A plastic bag with an adhesive facing is placed over the opening and firmly pressed onto the skin.

What happens right after the procedure?
The person often spends 5 to 7 days in the hospital. The stoma, or opening, is monitored for stool drainage, which should start about 72 hours after surgery. Food is not given until the bowel becomes active again. Before the person leaves the hospital, he or she is taught to care for the stoma. Advice regarding day-to-day living with an ostomy and referrals to support services, such as the Australian Council Of Stoma Associations (ACSA), may be provided. Concerns about changes in body image and sexuality are common and can also be addressed.

What happens later at home?
The person with a traditional procedure has no muscle control over the stoma. Stool discharge is continuous and liquid. Drainage bags, or pouches, must be worn at all times. The size of the opening and the pouch size will vary at first. The stoma is often checked 3 weeks after surgery, when swelling has gone away. The final size and type of appliance is selected after approximately 3 months, when the person's weight and stoma size is stable. Bag changing and other wound care should be done as instructed. A low residue diet is followed for the first 6 to 8 weeks. Strained fruits and vegetables may be given. Later, there may be few dietary restrictions. Foods that are high in fibre or contain hard-to-digest kernels, such as popcorn and celery, may need to be avoided. Otherwise, normal activity is usually permitted after recovery.

What are the potential complications after the procedure?
All surgery may result in bleeding, infection, and even death. Antibiotics can cause allergic reactions and stomach upset. Other side effects depend upon the antibiotic used. Skin irritation may result from watery stool that leaks under the drainage bag attachment. An incisional hernia, or the bulging of bowel through the incision, can occur. The opening may narrow, making drainage difficult. Scar tissue may cause bowel blockage.

Author: Barbara Mallari, RN, BSN, PHN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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