Ileostomy Closure

WHAT YOU SHOULD KNOW:

• An ileostomy closure is surgery to close your temporary ileostomy. An ileostomy is part of your ileum that is brought outside your body through a cut in your abdomen. Your ileum is the end part of your small intestine (bowel). The ileostomy forms a stoma (opening) for your bowel movements (BMs) to pass through. The stoma is secured to your skin and your BMs collect in a pouch or bag. You may have needed an ileostomy to protect your large intestine (colon) after surgery. You may have a temporary ileostomy if you had a diseased colon or a colon injury. A temporary ileostomy keeps your BMs out of your colon to prevent problems, such as an infection.
  
  
• An ileostomy closure is done once your colon has healed from surgery, disease, or injury. A temporary ileostomy is commonly closed within 8 to 12 weeks. During ileostomy closure, the cut ends of your ileum are reattached (sewn back together). Your BMs will begin to pass through your colon and out of your body through your anus again. Having your ileostomy closed may allow you more freedom to do your normal daily activities. Ileostomy closure may make you feel more at-ease when out in public.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During or after surgery, you may bleed from where your ileum is stitched or stapled. After surgery, fluids and BMs may leak from your ileum where it was sewn together. BMs that leak into your abdomen may cause an infection, which could spread through your body. You may get a wound infection or an infection in your intestines. An abscess (infected pus pocket) may form under your skin and need to be drained. Your wound may break open and need to be closed again. Your small intestine may become narrow and BMs may block your ileum. Your intestines may stop working for a short time after surgery.
  
  
• A fistula (abnormal tissue opening) may form between your small intestine and a nearby organ. You may get a hernia, which occurs when part of your intestine pushes through weak muscle in your abdomen. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If you do not have your ileostomy closed, you are at risk for skin damage around your stoma. Your skin may have an itchy rash and become red, swollen, and sore. Your intestines may become narrow or blocked. You may have many watery BMs leading to dehydration (loss of body fluid and salts). Your stoma may slip farther out of your abdomen, or pull inside your abdomen. You could get an infection inside your stoma that can spread to the rest of your body. Your BMs will continue to collect in a pouch or bag that needs to be emptied. Talk with your caregiver if you have questions or concerns about your surgery or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Medicines:
  
  
  • Antibiotic medicine: Antibiotic medicine helps prevent an infection caused by germs called bacteria. Antibiotics may be given before and after your surgery.
    
    
  
  
• Pre-op care: You are taken to the surgery room and moved to a table or bed.
  
  
• Anesthesia: This medicine is given to keep you comfortable during your surgery. You and your caregiver will decide the best kind of anesthesia for you. You may need any of the following:
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Spinal anesthesia: This medicine is put into your back through a shot to numb you below the waist. With spinal anesthesia, the feeling in your legs will return in about two hours.
    
    
  • Local anesthesia: This medicine is given as a shot into the skin. It is used to numb the surgery area and dull your pain.

During your surgery:

• Your caregiver will make an incision (cut) around your stoma. He will bring the cut ends of your ileum out of your abdomen. A small amount of the stoma tissue may be removed. Your caregiver uses stitches or staples to connect the cut ends of your ileum. Saline (salt water) may be given as a shot into your ileum to check for leaks. Your caregiver returns your reattached ileum into your abdomen through the cut.
  
  
• The body tissue layers where your stoma came through will be closed with stitches. A drain (thin rubber tube) may be placed under your skin to drain fluid from around your cut. The drain will be removed when your cut stops draining. Your skin may be closed with stitches or staples. Your caregiver may also leave some or all of the skin cut open to heal on its own. Your wound (surgery site) may be covered with a bandage.

After your surgery:

You are taken to a room to rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. When your caregivers see that you are not having any problems, you may be taken back to your room.

• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• Medicines: You may need the following:
  
  
  • Antidiarrheal medicine: This medicine is given to decrease the amount of diarrhea you are having. Some of these medicines coat the intestine (bowel) and make the BM less watery. Other antidiarrheal medicine works by slowing down how fast the intestine is moving.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Learn more about Ileostomy Closure (Inpatient Care)