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.

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.
  
  
• Tell your caregiver if you have a bleeding disorder, or heart or kidney disease. Tell your caregiver if you have had surgery before.
  
  
• Ask your caregiver if you need any tests before your surgery. Write down the date, time, and location of each test.
  
  
• You and your caregiver will talk about the best place on your abdomen for the stoma. Your caregiver may mark a few areas on your skin. Caregivers may talk with you about what it will be like to live with an ileostomy. You may be shown how your stoma and BMs may look after surgery. You may be given instructions on how to bathe, what to eat, and how to care for your stoma. Caregivers may talk about when you can return to work and other activities after surgery. Write down any questions you may have so you will remember to ask them at your visit. Bring a family member or friend with you to your visit, so they can also learn how to help you.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• You may need to drink a liquid medicine the night before your surgery that cleans out your bowel. You may not be able to eat or drink anything for a certain amount of time before your surgery. 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.
  
  
• Antibiotic medicine may be given to help prevent an infection caused by germs called bacteria.
  
  
• 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.
  
  
• 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 on a stretcher to the surgery room and moved to a table or bed. You will receive general anesthesia to keep you asleep and free from pain during surgery. If you are having colon surgery, it will be done first, before creating your ileostomy. An incision will be made in your abdomen where your stoma will come through. For an end ileostomy, your colon will be separated from your ileum and sewn closed. The end of your ileum will be brought through the cut in your abdomen. The end of the ileum will be 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 then sewn back together. Your tube-like ileum will be brought through the cut in your abdomen. A cut will be made only through the top of the ileum tube. Each cut end will be folded back and secured to the skin on your abdomen. The bottom part of your ileum will be pulled up through the cut in your skin. A rod may be placed under the bottom of the ileum tube 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 will create a stoma on your abdominal wall. The reservoir will be attached to the stoma on the inside of your abdomen. Your BMs will collect inside the reservoir and are removed with a tube. If a reservoir pouch is not made, BMs will empty out through your stoma and into a collection bag. The collection bag will be attached to the skin around your stoma.

After your surgery:

You will be 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 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 are late or cannot make it to your surgery.
  
  
• You have a fever.

Seek Care Immediately if

• You are unable to have a BM.
  
  
• You are urinating less than normal or not at all.
  
  
• You are vomiting (throwing up) and cannot eat or drink.
  
  
• You have blood in your BM, or you are vomiting blood.
  
  
• Your abdomen becomes tender (painful to touch) and hard.

Learn more about Ileostomy Creation (Precare)