Ileostomy

An ileostomy is formed by bringing part of the ileum to the surface of the abdomen. There are two types of ileostomy: end and loop. An ileostomy is generally sited on the right-hand side of the abdomen, but in some circumstances it may be made on the left-hand side. Ideally it has a spout of approximately 24-35mm. It should be pink in colour and moist.

The ileostomy has very little or no sensation and will reduce in shape and size between 6-8 weeks after formation. Normal output from an ileostomy is between 500-800ml in 24 hours. The consistency of the stools can range between watery to porridge-like.

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End Ileostomy

An end ileostomy is normally formed when the colon is removed and the ileum is brought out onto the surface of the abdomen. The end ileostomy may be temporary if the rectum and anus are left in situ (sub-total colectomy). If this is the case, the patient may be suitable for further surgery- for example, formation of an ileo-anal pouch. The ileostomy will be permanent if the colon, rectum and anus are removed (panproctocolectomy)

End Ileostomy

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Loop Ileostomy

A loop ileostomy is usually temporary and is normally created to divert faeces away from a surgical join in the colon or rectum (anterior resection). A loop of ileum is brought to the surface of the abdomen and opened to form a stoma. It has a working end (proximal) which produces faeces and a non-working end (distal) which leads to the colon and may produce mucus.

Loop Ileostomy

Ileoanal Pouch

Ileoanal pouch is an alternative operation for patients with ulcerative colitis, and avoids a permanent ileostomy. The operation involves the removal of the colon and the rectum, with replacement of the rectum by a reservoir or pouch made out of the ilenium. the operation can be carried out in 1, 2 or 3 stages, depending on the health and fitness of the patient and the hospital in which surgery is performed.

1. Occasionally, if there are no technical problems and the patient is well enough, the procedure can be carried out at a single operation. The colon and rectum are removed and an ileal pouch created without the need to an ileostomy.

1. The colon and rectum are removed and an ileal reservoir is created, with a covering loop ileostomy - all in one operation.
2. The ileostomy is closed.

1. The colon is removed, the rectum is left in place and an end ileostomy is formed. Once the patient is fit and well, stage 2 is performed.
2. The rectum is removed and an ileal reservoir is created and joined to the anus. In oredr to allow the join time to heal, a loop ileostomy is formed, which creates a temporary diversion for faecal matter.
3. The ileostomy is closed, allowing continuity of  the bowel.

Ileostomy Products / Appliances

An individual may wear either a 1-piece or 2-piece drainable appliance, depending on their lifestyle and personal preferences. It is normal to empty the appliance between 4-6 times in a 24-hour period, which will include overnight. The majority of ileostomates will wear a 1-piece appliance which is normally changed between 1-3 days. If the ostomate has chosen a 2-piece appliance, the base plate can be changed 2-3 times a week and the pouch changed every 1-3 days.

Appliances are available in a variety of sizes: mini, standard and large to suit individual requirements. They also come in transparent or opaque whilst some have a split cover, which allows the stoma to be seen for inspection. Most modern appliances have a filter which expels gas to prevent it from building up inside the pouch, and also a soft Velcro closure for comfort.

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One-piece pouch

Two-piece appliance: baseplate and pouch