Overview of Ileostomy
An ileostomy is a surgery that involves creating an opening in the abdomen and bringing a part of the small intestine, known as the ileum, out through this opening. This procedure can be done for a short time or could be a permanent solution, and can be in the form of a loop or an end. The intention of an ileostomy is to redirect the body’s waste pathway to the ileum instead of the usual route, which is through the rectum and out of the anus.
The waste that comes out of an ileostomy usually has a loose or mushy consistency, very similar to porridge. This is because the large intestine, which ordinarily makes the stool firm by absorbing water, is bypassed. The amount of waste that comes out from an ileostomy can vary but is usually between 200 and 700 ml per day. The ileostomy is usually located on the right side of the abdomen.
Anatomy and Physiology of Ileostomy
An ileostomy is a procedure that uses a part of the small intestine, specifically the ileum, to make an opening on the outside of the body. The small intestine, which is the place where most of the digestion of the food happens, starts from a part of the stomach called the pylorus. It is made up of three parts: the duodenum, the jejunum, and the ileum, which leads to the large intestine. These parts are all folded up inside the body and have a lot of blood vessels, lymph vessels, and nerves attached to them. The small intestine is usually 6 to 7 meters long and has different diameters, from 3 to 5 cm, depending on the part you’re looking at.
The small intestine ends at a place called the ileocaecal junction. After that point, the large intestine begins, starting with a part called the ascending colon. You can pinpoint the start of the large intestine because the linings of the bowel all meet up at that place.
When we perform the ileostomy surgery, we have to be careful about all the layers of the stomach wall. From the outside to the inside, these layers are the skin, a layer of fat, Scarpa’s and Camper’s fascia (layers of fibrous tissue), the anterior rectus sheath (a wrapping around the muscles), the muscles themselves, the posterior rectus sheath (another wrapping, if we are above a certain point in the belly), and finally the peritoneum (the inside lining of the general abdomen area).
The muscles in this area include the external and internal obliques, the transverse abdominis, and the rectus abdominis. All these muscles are connected at different places to the lower ribs and to the bony ridge around your waist, called the iliac crests. The rectus abdominis starts from the edge of the ribcage and the xiphoid process (a tiny pointed part of your sternum, or breastbone) and goes down to the pubic bone. All these muscles are not just surrounded by a layer of fibrous tissue, but they also have tough, flat bands of tissues called aponeuroses that meet up in the middle of the belly, forming the linea alba.
When creating an ileostomy, it’s important to place it in a way that goes through the muscle and the sheath (the wrap around the muscle). This is because, if it’s not done properly, there is a risk that part of the inside of your belly may push through the weak spot created by the surgery. This is known as a parastomal hernia.
Why do People Need Ileostomy
An ileostomy is a procedure in which a part of your small intestine, called the ileum, is rerouted to the outside of your abdomen. This allows the stool (feces) to pass out of your body without traveling through your large intestine (colon). It’s often created to bypass or isolate part of the digestive system that is impaired or ensuring it heals adequately after surgery.
There are two types of ileostomy: a loop ileostomy and an end ileostomy. A loop ileostomy is a temporary procedure. During this surgery, a loop of the small intestine is pulled out through a small opening in your belly (the stoma), creating two openings: one for stool to leave the body and the other to release mucus (which is naturally produced by the intestine). This type of ileostomy is typically done to protect a newly created connection in the intestines (anastomosis) after surgery, reducing the risk of leakage. Once the surgical area has healed, the loop ileostomy can be reversed, restoring the normal path for stool to pass through into the colon.
But it’s important to understand that the waste coming out of the ileostomy is from the small intestine alone, or the upper part of your digestive tract. If there’s a blockage in the colon, the ileostomy won’t relieve it, as it doesn’t allow your colon to expel waste or gas.
On the other hand, an end ileostomy is a permanent procedure where the entire colon has been removed, such as due to certain medical conditions like colorectal cancer or Crohn’s disease. In this surgery, the end of the small intestine is brought to the surface of the skin, creating a stoma. The stoma then becomes the permanent exit route for waste from the body.
So, to sum it up, the reasons for an ileostomy could include:
- To protect a surgically created connection in the bowel (distal anastomosis)
- To remove waste from the body if the entire colon has been removed due to conditions such as colorectal cancer, Crohn’s disease, ulcerative colitis or familial adenomatous polyposis
- To ease a blockage in the intestines
When a Person Should Avoid Ileostomy
An ileostomy is a procedure where a small opening is made in the stomach, called a stoma, to divert digestive waste out of your body. There are no absolute reasons why a person can’t go through with an ileostomy, but there are specific situations that may make it more difficult, including:
- Having a short mesentery (the tissue that attaches your small intestines to the wall of your abdomen). This could prevent the small intestine (ileum) from being re-routed through the wall of your stomach to the skin, especially in overweight individuals.
- Presence of widely spread cancer (carcinomatosis) that hinders the necessary movement of the small intestine.
The ileostomy should be created as far away as possible from the small intestine to leave enough of it for nutrient absorption. A high-output ileostomy (one that produces a large amount of waste) can lead to an imbalance of minerals in the body – this is especially important to watch in people with kidney problems. It can also lead to poor absorption of nutrients potentially leading to malnutrition.
When constructing an ileostomy, it’s critical to guide the waste flow away from the skin to avoid irritation. The stoma (artificial opening in the stomach) should also be positioned away from scars, skin creases, and bony parts of the body. This allows for easier application of the stoma “bag” (appliance) and helps to prevent leakage.
Equipment used for Ileostomy
The medical tools needed can be divided into two parts: the procedure stage and the care stage. During the procedure stage, creating the ileostomy (a surgical opening made in the abdomen for waste removal) requires a variety of surgical tools. These will be mentioned later.
The care stage focuses on teaching the patient about ileostomy care and how they will handle it. This will involve using ileostomy bags, and potentially additional sticky materials like sprays, powders, pastes and rings for extra support. There may also be a need for belts, sprays to remove the adhesive, wet wipes, and bags to dispose of waste.
Preparing for Ileostomy
Preparing for a surgery that might involve getting a stoma, a small opening on the abdomen, requires both physical and psychological readiness. Stoma nurses, who are expert healthcare professionals, provide support throughout this process. The type of physical preparations can change based on the specifics of your surgery and whether it’s an emergency procedure or previously planned.
Some of the things to think about before surgery include:
* Trimming body hair around the abdominal area
* Your Body Mass Index (BMI), which is a measurement of your weight in relation to your height. If you are having a planned ileostomy (surgery to create an opening from your small intestine to the surface of your skin), you might be asked to lose some weight. This can help make the anesthetic work better and reduce the distance that the surgeon needs to work through to bring the small bowel to the skin without causing strain.
* If you’ve had previous surgeries, this could mean there are internal scar tissues (also known as adhesions) that might affect the new procedure.
* The presence of hernias, or bulges that occur when an organ pushes through an opening in the muscle or tissue that holds it in place.
* Your lifestyle habits like smoking and diabetes control can affect how well your wound heals after surgery.
The most important concern is where to place the stoma. It’s normally on the right side of your belly, at the edge of the ‘abs muscle’, where you can easily see and reach it. It should be placed in a spot that doesn’t interfere with belts or folds in your skin, and also avoid the rib cage and belly button. In cases of blocked or ruptured bowel, or if there’s a risk of the intestines not working properly after surgery (a condition known as ileus), a tube inserted through the nose and into the stomach (nasogastric tube) may be used. Making sure you have enough fluid and minerals in your body before surgery is also very important.
How is Ileostomy performed
Before any surgical procedure, the surgeon will usually mark the location on the patient’s body where the operation will be done. This can be done with a special type of ink that won’t easily wash off or even with a small etch in the skin. This step is crucial because it ensures that the surgeon knows exactly where to work, even after hours of surgery when any pre-existing marks could be washed away or obscured.
In this case, the operation may involve creating what’s known as an ileostomy. This is when a surgeon makes a small opening in the belly, called a stoma, and brings a part of the small intestine, known as the ileum, out through this opening. The opening functions as a new pathway for waste to exit the body and is typically used when the colon can’t perform this process.
There are two main types of ileostomies – loop ileostomy and end ileostomy. The actual process of creating an ileostomy involves several important steps. First, a small piece of skin is removed from the belly area and the underlying layers of fat and muscle are carefully moved aside to reveal the membrane that lines the inside of the belly, known as the peritoneum. A cut is made in the peritoneum to gain access to the abdominal cavity and part of the ileum is carefully passed through this opening.
The surgeon will then use a special type of thread to secure the ileum into place, ensuring it won’t slide back into the belly. This allows the surgeon to focus on other important aspects of the operation, such as ensuring that everything is in the right orientation and that there’s no active bleeding.
The main difference between a loop and an end ileostomy is what part of the ileum is brought up through the stoma. For a loop ileostomy, a loop of the ileum is brought up through the stoma, hence the name. The end of the loop is then cut open to create the new passageway for waste. On the other hand, for an end ileostomy, the very end of the ileum is brought up through the stoma and the end is cut off and opened to create the new passageway.
In both cases, the ileostomy is typically created last in the operation to minimize risk of any contaminants from the ileum getting on the surgical wounds. Once the ileostomy is complete, the surgeon will apply dressings to the surgical wounds and then focus on the final formation of the ileostomy.
Possible Complications of Ileostomy
There are different types of complications that can happen after intestinal stoma surgery, which is a procedure that creates an opening in the belly for waste to leave the body. These complications can occur immediately after surgery, soon after, or much later. They can be specific to this procedure or more general in nature. About 20% of patients getting this surgery experience some kind of complication. The type of complications someone might face can depend on the exact type of surgery required for their ileostomy, which is a type of intestinal stoma.
Some of the specific complications to this procedure can include:
* Stenosis: This is when the opening of the stoma narrows.
* Ischemia/Necrosis: This refers to when tissue around the stoma doesn’t get enough blood and starts to die.
* Hemorrhage: This means severe bleeding.
* Infection/Abscess: An infection can occur at the surgery site, causing an abscess, which is a pocket of pus.
* Parastomal hernia: This is when part of the intestines pushes through the muscles around the stoma.
* Retraction/Prolapse: Retraction is when the stoma withdraws into the body, and prolapse is when the stoma extends further out from the body.
* Electrolyte imbalance: This can happen due to a high amount of fluid coming out of the ileostomy, affecting the balance of minerals in the body.
* Dehydration: High fluid output can also cause the body to lose too much water, leading to dehydration.
* Renal impairment: This is harmful damage or changes to the kidneys.
* Hematoma/Seroma: These are collections of blood or fluid under the skin.
* Obstruction: This refers to a blockage in the intestines.
* Fistula formation: A fistula is an abnormal connection or tunnel between two parts of the body.
* Skin irritation: The skin around the stoma can become irritated or inflamed.
What Else Should I Know About Ileostomy?
The creation of an ileostomy, which involves making an opening in the belly that allows waste to bypass the normal path and exit the body, is a significant operation often conducted either in an emergency or as a planned surgery. This procedure is done for the patient’s well-being, aiming to enhance their life quality or even to save their life. It’s essential to reassure patients that even with an ileostomy, they can still lead a regular lifestyle and go on with their everyday activities.
