Ileostomy Creation

WHAT YOU SHOULD KNOW:

• An ileostomy is a stoma, created from your ileum, for bowel movements (BMs) to pass through. Your ileum is the last part of your small intestine. A stoma is a temporary or permanent opening in your ileum brought out through a skin cut. Your small intestine is a long tube that connects to your stomach at the top. The bottom of your small intestine (ileum) connects to your large intestine (colon). You digest (break down so your body can absorb it) your food in your small intestine. Your colon absorbs extra fluid and nutrients from your digested food, and turns the food into BMs.
  
  
• When you have an ileostomy, your digested food does not enter your colon. Your digested food leaves your body though your stoma in the form of mushy BMs. You may need an ileostomy to allow your colon time to heal after colon surgery. Colon surgery may be done to remove a blockage, polyp (growth), infection, or cancer. After colon surgery, there is a risk your BMs will leak through the area that has been sewn together. A leak can lead to a life-threatening infection in your abdomen. You may also need an ileostomy if you have an abdominal injury or a spinal cord injury causing paralysis. Paralysis means you cannot move areas of your body.
  
  
• An ileostomy can decrease the risk of infection after colon surgery. An ileostomy allows BMs to leave your body if you need part, or all, of your colon removed. An ileostomy may allow you to care for yourself better if you are paralyzed from the waist down. An ileostomy may allow your colon to heal after a major surgery or injury to your abdomen.

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:

• Surgery may cause bleeding or damage to nearby organs. A fistula (abnormal tissue connection) may form between your intestines and another organ. Your intestines may stop working for a period of time after surgery. You may get a blood clot in your arm or leg that causes pain and swelling. A blood clot 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, and can be life threatening.
  
  
• Your stoma or areas along your intestines may narrow or become blocked. The stitches securing your ileostomy may come loose. Your stoma may slip back into your body, or come out too far on your abdomen. The rod holding your stoma in place may create a hole in your skin. You may have pain, a skin rash, or BM leaks around your stoma. You may get an infection in your intestines, reservoir pouch, urinary tract, or the skin around your stoma. The skin and intestine that forms your stoma could die. You could get a hernia (intestine that pushes through a weakened abdominal muscle wall). If you have large, liquid BMs, you may lose too much body fluid and your kidneys may fail.
  
  
• Without an ileostomy after colon surgery, you BM may leak through your colon into your abdomen. The leaks can cause a serious infection that may spread to your entire body, and you could die. If you are paralyzed, you may not be able to control your BMs. You may not be able to feel when you are having a BM. For some bowel diseases, you may not be able to receive proper treatment without an ileostomy. Without proper treatment, your disease may get worse, and you may die. Talk with your caregiver if you have questions or concerns about your surgery, treatment, 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.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• 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.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Medicines:
  
  
  • Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
    
    
  • Antibiotic medicine: Antibiotic medicine may be given to help prevent an infection caused by germs called bacteria. You may have antibiotic medicine before and after your surgery.
  
  
• Pre-op care: You may be given medicine that makes you relaxed and sleepy right before your surgery. You are taken on a stretcher to the surgery room and moved to a table or bed.
  
  
• 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.
  
  
• Foley catheter: A Foley catheter is a tube placed in your bladder to drain your urine into a bag. You may need a Foley catheter both during and after your surgery. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink and block the flow of urine.
  
  
• Nasogastric tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty.

During your surgery:

• If you are having colon surgery, it is done first, before creating your ileostomy. To create your ileostomy, an incision is made in your abdomen where your stoma will come through. For an end ileostomy, your colon is separated from your ileum and sewn closed. The end of your ileum is brought through the cut in your abdomen. The end of the ileum is folded back on itself, and stitched to the skin of your abdomen.
  
  
• A loop ileostomy is created when a section of your colon is removed and sewn back together. Your tube-like ileum is brought through the cut in your abdomen. A cut is made only through the top of the ileum tube. Each cut end is folded back and secured to the skin on your abdomen. The bottom of your ileum is pulled up through the cut in your skin. A rod may be placed under the bottom part of the ileum to secure it above your skin.
  
  
• Your caregiver may create a reservoir (pouch) that stays inside your body from a part of your ileum. To create the reservoir, your caregiver creates a stoma on your abdominal wall. The reservoir attaches to the stoma and stay inside your abdomen. Your BMs collect inside the reservoir and are removed with a tube. If a reservoir is not made, BMs empty out through your stoma and into a collection bag. The collection bag attaches to the skin around your stoma.

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.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. After an ileostomy, you may not be able to eat solid food for many days. Ice chips are usually given first. Liquids, such as water, broth, apple juice, or lemon-lime soft drinks, may be allowed within a few days.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Medicines:
  
  
  • 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.
    
    
  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass. You may begin to pass BMs through your ileostomy within 1 to 3 days after surgery.
  
  
• Self-care: Before you leave the hospital, caregivers may teach you and a family member how to care for your ileostomy. You may be taught how to empty and change your ileostomy bag and how to care for your skin. After showing you how to care for your ileostomy, caregivers may have you practice doing it yourself.

Learn more about Ileostomy Creation (Inpatient Care)