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.

Getting Ready

Before your surgery:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• You may need an enema (liquid put in your rectum) before your surgery. The enema has a dye in it that shows up on an x-ray. The enema and x-ray check for leaks in your colon where your past surgery was done. Your caregiver may also check your anal sphincter to make sure it is working properly. Your anal sphincter is a muscle that keeps BMs in your rectum. Your rectum is the end of your colon that holds your BMs until they pass out of your anus. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.

The night before your surgery:

• You may need to drink a special medicine the night before your surgery to help empty out your bowel. Ask your caregiver for directions about eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Antibiotic medicine may be given before your surgery to help prevent infection caused by germs called bacteria.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the surgery room and moved to a table or bed. Medicine called anesthesia will be given to make you more comfortable during your surgery. The medicine may numb the area, or keep you asleep and pain-free 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 will use 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 will return your reattached ileum to 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. You may be given medicine to help decrease or take away pain. When caregivers see that you are not having any problems, you may be taken back to your room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• The skin around your stoma is red, warm, and sore.
  
  
• You have a fever.
  
  
• You have an itchy skin rash around your stoma.
  
  
• You have nausea (upset stomach) or vomiting (throwing up).
  
  
• You have tenderness (pain when touched) or swelling in your abdomen.

Seek Care Immediately if

• You are not passing BMs through your stoma.
  
  
• You have pus draining from your stoma.
  
  
• Your abdomen is swollen, hard, painful, and you are vomiting.
  
  
• Your stoma has sunk back in to your abdomen.
  
  
• Your stoma slips farther out of your abdomen than it should be.

Learn more about Ileostomy Closure (Precare)