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{{Short description|Surgical procedure}}
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{{Infobox interventions
| Name = Ileostomy
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'''Ileostomy''' is a [[stoma (medicine)|stoma]] (surgical opening) constructed by bringing the end or loop of [[small intestine]] (the [[ileum]]) out onto the surface of the skin, or the surgical procedure which creates this opening.<ref name=":2">{{Cite web |title=Types of ileostomy: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000073.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref> Intestinal waste passes out of the ileostomy and is collected in an external [[Ostomy pouching system|ostomy system]] which is placed next to the opening. Ileostomies are usually sited above the [[groin]] on the right hand side of the [[abdomen]].
==Uses==
Ileostomies are necessary where injury or a surgical response to disease has meant the [[large intestine]] cannot safely process waste, typically because the [[colon (anatomy)|colon]] and [[rectum]] have been partially or wholly removed.
Diseases of the large intestine which may require surgical removal include [[Crohn's disease]], [[ulcerative colitis]], [[familial adenomatous polyposis]], and total colonic [[Hirschsprung's disease]].<ref name="Guide">[http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Ileostomy.asp ''Ileostomy Guide''] {{Webarchive|url=https://web.archive.org/web/20070929091245/http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Ileostomy.asp |date=2007-09-29 }}; by the [[American Cancer Society]]; Cancer.org website; retrieved January 2014.</ref> An ileostomy may also be necessary in the treatment of [[colorectal cancer]] or [[ovarian cancer]]. One example is a situation where the cancer [[tumor]] is causing a blockage (obstruction).<ref>{{cite web |last1=Services |first1=National Health |title=Why it's used - Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/why-its-done/ |website=NHS |
In an ''end ileostomy'', the end of the ileum is everted (turned inside out) to create a spout and the edges are sutured under the skin to anchor the ileum in place. Permanent ileostomies are usually done this way. An end ileostomy may be temporary, notably if some of the large intestine was removed and the bowel or overall health is not considered amenable to tolerating further surgery, such as an [[anastomosis]] to rejoin the small and large intestines.
=== Duration ===
In a ''temporary'' or ''loop ileostomy'', a loop of the ileum is surgically brought through the skin creating a stoma, but keeping the lower portion of the ileum for future reattachment in cases where the entire colon and rectum are not removed but need time to heal. Temporary ileostomies are also often made as the first stage in surgical construction of an [[ileo-anal pouch]], so [[Human feces|fecal]] material
==Living with an ileostomy==
[[File:Ileostomy 2016-09-09 4158.jpg|thumb|Ileostomy with bag (pouch).]]{{See also|Ostomy system}}
People with ileostomies must use an ''[[Ostomy pouching system|ostomy pouch]]'' to collect intestinal waste. People with ileostomies typically use an open-ended (referred to as a "drainable") one- or two-piece pouch that is secured at the lower end with a leakproof clip, or velcro fastener. The alternative is the closed-end pouch that must be thrown away when full. Ordinarily, the pouch must be emptied
Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the pouch becomes too full. It is necessary to measure the stoma regularly as it changes shape after the initial surgery. The stomal- or colorectal-nurse does this initially for a patient and advises them on the exact size required for the pouch's opening. Changes in size and shape can indicate a problem and may signal a need to call a healthcare provider.<ref name=":3" />▼
Some people find they must make adjustments to their diet after having an ileostomy. It is important for individuals to consult with their healthcare providers.<ref name=":1" /> Tough or high-[[Dietary fiber|fiber]] foods (for example: potato skins, tomato skins, and raw vegetables) are hard to [[digestion|digest]] in the small intestine and may cause blockages or discomfort when passing through the stoma. Chewing food thoroughly can reduce such problems.<ref name=":1" /> Some people find that certain foods cause annoying gas or [[diarrhea]].<ref name=":4">{{Cite web |title=Ileostomy and your diet: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000070.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref> Many foods can change the color of the intestinal output, causing alarm; beetroot, for instance, produces a red output that may appear to be blood.<ref name=":4" /> Nevertheless, people who have an ileostomy as treatment for [[inflammatory bowel disease]] typically find they can enjoy a more "normal" diet than they could before surgery. Correct dietary advice is essential in combination with the patient's gastroenterologist and hospital-approved dietician. Supplementary foods may be prescribed and liquid intake and output monitored to correct and control output. If the output contains blood, an ileostomate (patient) is advised to visit an emergency department.<ref>{{cite web |publisher=National Health Service |title=Living with an ileostomy -Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/living-with/ |website=NHS |
▲Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the pouch becomes too full. It is necessary to measure the stoma regularly as it changes shape after the initial surgery. The stomal- or colorectal-nurse does this initially for a patient and advises them on the exact size required for the pouch's opening.
After having ileostomies, people may continue to take baths and showers and have an active lifestyle.<ref name=":1" /><ref>{{Cite web |title=Living with your ileostomy: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000075.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref> These and other topics are important to discuss with healthcare providers.<ref>{{Cite web |title=Ileostomy - what to ask your doctor : MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000227.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref>
▲Some people find they must make adjustments to their diet after having an ileostomy. Tough or high-[[Dietary fiber|fiber]] foods (for example: potato skins, tomato skins, and raw vegetables) are hard to [[digestion|digest]] in the small intestine and may cause blockages or discomfort when passing through the stoma. Chewing food thoroughly can reduce such problems. Some people find that certain foods cause annoying gas or [[diarrhea]]. Many foods can change the color of the intestinal output, causing alarm; beetroot, for instance, produces a red output that may appear to be blood. Nevertheless, people who have an ileostomy as treatment for [[inflammatory bowel disease]] typically find they can enjoy a more "normal" diet than they could before surgery. Correct dietary advice is essential in combination with the patient's gastroenterologist and hospital-approved dietician. Supplementary foods may be prescribed and liquid intake and output monitored to correct and control output. If the output contains blood, an ileostomate (patient) is advised to visit an emergency department.<ref>{{cite web |publisher=National Health Service |title=Living with an ileostomy -Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/living-with/ |website=NHS |accessdate=11 September 2020}}</ref>
Complications can include [[kidney stones]], [[gallstones]], and [[adhesion (medicine)|post-surgical adhesions]].<ref>{{cite journal |vauthors=Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM |others=Surgical and Clinical Adhesions Research (SCAR) Group |title=The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. |journal= Colorectal
</ref>
==Other options==
In some patients with Crohn's disease, a procedure called an [[ileoanal anastomosis]] is done if the disease affects the entire colon and rectum, but leaves the anus unaffected. In this procedure, the entire large intestine and rectum is surgically removed, and the ileum is then stitched to the anus to allow fecal matter to go through the ileum just as it did when the patient had a large intestine. This procedure requires a temporary loop ileostomy to allow the anastomosis to heal. With lifestyle adjustments, those who have had this procedure for their Crohn's disease can resume normal bowel movements without artificial appliances. However, there is always the possibility of disease relapse, as
<!-- Anchor from redirected article, [Barnett continent intestinal reservoir]; caution when changing. -->
Since the late 1970s, an increasingly popular alternative to an ileostomy has been the ''Barnett continent intestinal reservoir'' (or BCIR). The formation of this pouch (made possible through a procedure first pioneered by
=== Barnett continent intestinal reservoir ===
The Barnett continent intestinal reservoir (BCIR) is a type of an appliance-free intestinal [[ostomy]]. The BCIR was a modified [[Kock pouch]] procedure pioneered by William O. Barnett. It is a surgically created pouch, or reservoir, on the inside of the [[abdomen]], made from the last part of the [[small intestine]] (the [[ileum]]),<ref name="Reference 13" /> and is used for the storage of intestinal [[
====How it works====
The pouch works by storing the liquid waste, which is drained several times a day using a small silicone tube called a [[catheter]]. The catheter is inserted through the surgically created opening on the abdomen into the pouch called a [[Stoma (medicine)|stoma]]. The capacity of the internal pouch increases steadily after surgery: from
The opening through which the catheter is introduced into the pouch is called the [[Stoma (medicine)|stoma]]. It is a small, flat, button-hole opening on the abdomen. Most patients cover the stoma site with a small pad or bandage to absorb the [[mucus]] that accumulates at the opening.<ref name="Reference 6" /><ref group=Note name=Note02/> This mucus formation is natural, and makes insertion of the catheter easier. The BCIR requires no external appliance and it can be drained whenever it is convenient. Most people report draining the pouch 2–4 times a day, and most times they sleep through the night. This can vary depending on what kinds and quantities of food eaten. The process of draining the pouch is simple and quickly mastered. The stoma has no nerve endings, and inserting the catheter is not painful. The process of inserting the catheter and draining the pouch is called ''[[intubation]]'' and takes just a few minutes.
====Background and origin====
Finnish surgeon
After a test series of over 300 patients,
====Surgical candidates====
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Candidates for BCIR include: people who are dissatisfied with the results of an alternate procedure (whether a conventional Brooke ileostomy or another procedure); patients with a malfunctioning/failed Kock pouch or [[Ileo-anal pouch|IPAA/J-pouch]]; and individuals with poor [[internal anal sphincter|internal]]/[[external anal sphincter]] control who either elect not to have the J-pouch (IPAA) or are not a good candidate for IPAA.<ref name="Reference 1" />
There are, however, some contraindications for having the BCIR surgery. BCIR is not for people who have or need a [[colostomy]], people with [active] [[Crohn's disease]], mesenteric
When Crohn's disease only affects the colon, it may, in select cases, be appropriate to perform a BCIR as an alternative to a conventional ileostomy. If the small intestine is affected, however, it is not safe to have the BCIR (because the internal pouch is created out of the small intestine, which must be healthy).
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;ASCRS special study, 1999
In 1999, American Society of Colon and Rectal Surgeons published a unique study on 42 patients with a failed [[Ileo-anal pouch|IPAA/J-pouch]] who converted to the Barnett modification of the Kock pouch (BCIR). The authors noted that their study was significant in the very large number of patients,<ref name="Reference 3" /> approximately 6 times more than studied by any previous author.<ref name="Reference 4" /> The study was published in ''Diseases of the Colon and Rectum'' in April 1999.<ref name="Reference 4" /> The study found:
:* that forty (95.2%) patients of the failed [[Ileo-anal pouch|IPAA]] population reported fully functioning pouches;
:* that two pouches had been excised, one after development of a pouch vesical fistula, the other after emergence of [[Crohn's disease]], which had not been diagnosed at the time of the original [[colectomy]];
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<ref name=Note01>The intestinal collar communicates with the pouch in such a way that buttresses the nipple valve and conduit, providing increased security against leakage.</ref>
<ref name=Note02>Patients may place a simple dressing over the flush stoma.</ref>
<ref name=Note03>
<ref name=Note04>Leakage through one of the reservoir suture lines used to be a much more common complication than it is today, thanks to improved construction of the reservoir and careful selection of patients.</ref>
<ref name=Note05>There is no cure for ulcerative colitis, but surgery may be recommended in chronic cases where medical therapy fails. Surgical options include a proctocolectomy, or creating a Brooke ileostomy or continent ileostomy.</ref>
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<ref name="Reference 2">Vernava III, A. M.; Goldberg, S. M. (1 June 1988), "Is the Kock pouch still a viable option?", International Journal of Colorectal Disease (Springer-Verlag) 3(2):135-138, {{doi|10.1007/BF01645320}}, {{ISSN|0179-1958}}</ref>
<ref name="Reference 3">Behrens, Donald T.; Paris, Martin; Luttrell, Josiah. (May 1999), "The Authors Reply", Diseases of the Colon & Rectum (American Society of Colon and Rectal Surgeons) 42(5)</ref>
<ref name="Reference 4">Behrens, Donald T.; Paris, Martin; Luttrell, Josiah. (April 1999), "Conversion of failed ileal pouch-anal anastomosis to continent ileostomy", Diseases of the Colon & Rectum (American Society of Colon and Rectal Surgeons) 42(4):490-6. {{doi|10.1007/BF02234174}}</ref>
<ref name="Reference 5">Barnett, William. (January 1989), "Current Experiences with the Continent Intestinal Reservoir", Surgery, Gynecology & Obstetrics, 168:1-5. {{PMID|2535766}}</ref>
<ref name="Reference 6">{{cite book|last=Corman|first=Marvin|title=Colon and Rectal Surgery|year=1993|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0397511785|pages=966–973}}</ref>
<ref name="Reference 7">Lian L, Fazio VW, Remzi FH, Shen B, Dietz D, Kiran RP. (August 2009) "Outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis", Diseases of the Colon & Rectum (American Society of Colon and Rectal Surgeons) 52(8):1409-14; discussion 4414-6, {{doi
<ref name="Reference 8">McLeod RS. (2003), "Surgery for inflammatory bowel diseases", Dig. Dis. 21(2):168-79. {{doi|10.3748/wjg.14.2678}}</ref>
<!-- This reference not used in the text<ref name="Reference 9">Nessar G, Fazio VW, Tekkis P, Connor J, Wu J, Bast J, et al. (March 2006), "Long-term outcome and quality of life after continent ileostomy", Diseases of the Colon and Rectum, 49(3):336-44.</ref> -->
<ref name="Reference 10">{{cite web|last=Dietz|first=David|title=Familial Adenomatous Polyposis (FAP)|url=http://www.fascrs.org/physicians/education/core_subjects/2006/fap/|publisher=ASCRS|
<ref name="Reference 11">{{cite web|title=Ulcerative Colitis|url=http://www.fascrs.org/patients/conditions/ulcerative_colitis/|publisher=ASCRS|
<ref name="Reference 12">{{cite web|title=Colorectal Diseases and Treatments|url=http://www.fascrs.org/aboutus/press_room/backgrounders_and_tip_sheets/colorectal/|publisher=ASCRS|
<ref name="Reference 13">{{cite web|title=Ostomy|url=http://www.fascrs.org/patients/treatments_and_screenings/ostomy/|publisher=ASCRS|
}}
==External links==
* [http://ileostomy-surgery.com ''Ileostomy-surgery''] {{Webarchive|url=https://web.archive.org/web/20131231204816/http://ileostomy-surgery.com/ |date=2013-12-31 }} website
* [http://www.fascrs.org/ ''American Society of Colon & Rectal Surgeons'']; ASCRS website
* ''[http://www.ostomy.org/ United Ostomy Associations of America]''; Ostomy Association website (visited: May 23, 2018)
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{{Stomas}}
{{Digestive system surgical procedures}}
{{Authority control}}
{{DEFAULTSORT:Ileostomy}}
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