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ileostomy care Images (Click to view larger image)
Alternative Names
ileum surgery ileostomy
Definition
The ileum is the last portion of the small intestine, which connects to the large intestine. Sometimes a section of intestine must be removed surgically because of bowel disease, and a new way for stool to leave the body must be created. When the surgeon makes an opening in the abdomen for the stool to pass through, this surgery is called an ileostomy, and the opening into the abdomen is called a stoma.
A team of people, including a surgeon, nurse, social worker, and dietician, may provide ileostomy education and initial care. An enterostomal therapist, who is usually an RN with specialised training, might also assist with care. Care might extend well past the initial hospital stay.
Who is a candidate for the procedure?
A person needing an ileostomy might have experienced bowel infections, blockages, or injuries. The person might have cancer. Severe inflammatory bowel conditions, such as Crohn's disease, might result in an ileostomy.
How is the procedure performed?
Ileostomy education begins before surgery. The doctors may use diagrams, photographs, and examples of equipment to explain what the person can expect after surgery. Concerns related to changes in body image and sexuality can be explored.
A traditional ileostomy is performed when the surgeon attaches the bottom of the ileum to the outside opening or stoma. The contents of the bowel are allowed to drain into a bag. An ileostomy may be temporary, to be closed and repaired later, or it may be permanent. Continent ileostomy, or a Kock procedure, is possible in some cases. In this procedure, an intestinal reservoir is created. The person empties the reservoir 2 to 4 times a day by inserting a drainage tube.
In a traditional type, the stool drains continuously into the drainage bag and is fluid. Stool usually begins to drain from the ileostomy about 72 hours after surgery. A nurse or enterostomal therapist will initially care for the ileostomy. The person will be taught how to manage the device and gradually take over the care of the stoma and the surrounding skin.
The stoma is red, oval, and looks like the skin on the inside of the lower lip. The surgeon will place the stoma in a location on the abdomen where the person can care for it easily. A drainage bag or pouch with an adhesive backing is applied to the skin around the stoma. The stoma and pouch size will vary at first. The stoma size is often checked 3 weeks after surgery, when swelling has subsided. The final size of the appliance may be determined after about 3 months, when a person's weight has stabilised.
What happens right after the procedure?
Careful skin care and a well-applied pouch will help to prevent skin problems. The doctor will assist with the initial choice and fitting of the appliance. Most pouches are odour-resistant and disposable. The appliance is emptied every 4 to 6 hours. An emptying spout is located at the bottom of the appliance. The appliance is usually changed every 5 to 7 days.
Before a fresh pouch is applied, the skin around the stoma is gently cleansed with a mild soap and patted dry. A gauze dressing may be used to cover the stoma during cleansing. The doctor may order nystatin powder to be used on the skin around the stoma, if irritation or a yeast infection is present. A skin barrier, which might be a wafer or paste, is then applied. The backing of the adhesive surface of the pouch is removed, and the bag is pressed down firmly around the stoma.
A low-residue diet, including items such as strained fruits or vegetables, is followed for the first 6 to 8 weeks. Later, there are few dietary restrictions. Foods that are high in fibre, have hard-to-digest kernels, or are odour-producing may need to be avoided. A dietician can help the person establish a balanced diet. Fluid loss can be a problem in the summer, because perspiration adds to the fluid lost through the ileostomy. Electrolytes can be lost. Sports drinks containing electrolytes may be helpful in maintaining good fluid balance and avoiding dehydration and salt imbalance.
A person receiving an ileostomy has many questions about lifestyle changes. Family relationships, sexual function, and body image are all areas of concern to be discussed with a doctor. Adjustment to life with an ileostomy, and monitoring for complications, will be an ongoing process.
What happens later at home?
Visits from nurses or therapists can help with questions of day-to-day living. Referrals may given to support organisations, such as the Ostomy Associations of Queensland.
What are the potential complications after the procedure?
Any surgery can result in bleeding, infection, or even death. The most common problem associated with ileostomy is skin irritation and breakdown from stool that does not drain properly. Diarrhoea, or liquid stool that fills the pouch very rapidly, can lead to dehydration and salt imbalance. Circular scar tissue may narrow the stoma. Kidney stones and gallstones occur more frequently in persons with an ileostomy.
Author: Barbara Mallari, RN, BSN, PHN
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 12/06/2005
Contributors
Potential conflict of interest information for reviewers available on request |
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