WHAT TO EXPECT FROM COLOSTOMY AND ILEOSTOMY

Introduction

A colostomy is a surgical procedure that diverts the colon through an opening in the abdominal wall to the outside of the body. This allows waste products to be collected in a pouch or bag attached to the skin around the stoma. The purpose of a colostomy is to divert the flow of stool away from the rectum and anus, allowing the rectum and anus to heal after injury or surgery.

An ileostomy is a similar procedure, but it involves the small intestine instead of the colon. In an ileostomy, the small intestine is brought through the abdominal wall and connected to the skin around the stoma, allowing waste products to be collected in a pouch or bag. The purpose of an ileostomy is also to divert the flow of stool away from the rectum and anus, allowing the rectum and anus to heal after injury or surgery.

There are several types of colostomies and ileostomies, including:

• End colostomy: In this type of colostomy, the end of the colon is brought through the abdominal wall and connected to the skin around the stoma.
• Loop colostomy: In this type of colostomy, a loop of colon is brought through the abdominal wall and connected to the skin around the stoma.
• Ileo-anal reservoir (J-pouch): In this type of ileostomy, the small intestine is brought through the abdominal wall and connected to the anus, creating a reservoir that collects waste products.

The procedures for creating a colostomy and ileostomy are similar, and typically involve the following steps:

1. Preparation: The patient will undergo a series of tests and examinations to ensure that they are healthy enough for the procedure.

2. Anesthesia: The patient will be given general anesthesia to ensure that they do not feel pain during the procedure.

3. Incision: The surgeon will make an incision in the abdomen to access the colon or small intestine.

4. Diversion: The surgeon will divert the flow of stool away from the rectum and anus, and bring the colon or small intestine through the abdominal wall and connect it to the skin around the stoma.

5. Closure: The surgeon will close the incision in the abdomen with sutures or staples.

6. Post-operative care: The patient will be monitored closely for any complications, and will be given pain medication as needed.

After the procedure, the patient will need to follow a special diet and take care of their stoma to prevent complications. They may also need to use a pouching system to collect waste products.

 

Procedure of colostomy and ileostomy explained

A) Colostomy Procedure:

A colostomy is a surgical procedure that involves creating an opening in the abdominal wall through which a portion of the colon (large intestine) is brought to the surface. This opening, called a stoma, allows for the diversion of stool from the normal route through the rectum and anus. Colostomies are typically performed when there is a need to bypass or remove a diseased or damaged part of the colon, or when there is an obstruction that prevents stool from passing through.

The procedure begins with the patient being placed under general anesthesia. The surgeon then makes an incision in the abdomen, usually on the left side, and carefully brings a loop of the colon to the surface. The specific location of the stoma may vary depending on individual factors such as body shape and medical condition.

Once the loop of colon is brought out, it is sutured to the abdominal wall to create the stoma. The stoma is typically round or oval-shaped and protrudes slightly above the skin surface. The surgeon ensures that it is positioned in a way that allows for easy access and management.

After creating the stoma, the surgeon may place a temporary colostomy bag over it to collect waste material. This bag can be emptied or replaced as needed. In some cases, a permanent colostomy may be necessary, and a more permanent pouching system will be used.

Following the procedure, patients are closely monitored for any complications or signs of infection. They are provided with instructions on how to care for their stoma and manage their colostomy bag. A healthcare professional will guide them on proper hygiene, changing of bags, and diet modifications if necessary.

B) Ileostomy Procedure:

An ileostomy is a surgical procedure that involves creating an opening in the abdominal wall through which a portion of the small intestine called the ileum is brought to the surface. Similar to a colostomy, an ileostomy allows for the diversion of stool when there is a need to bypass or remove a diseased or damaged part of the small intestine.

The procedure begins with the patient being placed under general anesthesia. The surgeon then makes an incision in the abdomen, typically on the right side, and carefully brings a loop of the ileum to the surface. The location of the stoma may vary depending on individual factors.

Once the loop of ileum is brought out, it is sutured to the abdominal wall to create the stoma. The stoma is usually small and round, and it protrudes slightly above the skin surface. The surgeon ensures that it is positioned in a way that allows for easy access and management.

After creating the stoma, a temporary ileostomy bag may be placed over it to collect waste material. This bag can be emptied or replaced as needed. In some cases, a permanent ileostomy may be necessary, and a more permanent pouching system will be used.

Post-surgery, patients are closely monitored for any complications or signs of infection. They receive instructions on how to care for their stoma and manage their ileostomy bag. A healthcare professional will guide them on proper hygiene, changing of bags, and dietary adjustments if required.

 

Evaluation of colostomy and ileostomy as surgical management

Colostomy and ileostomy are surgical procedures used to manage certain medical conditions that affect the digestive system. These procedures involve creating an opening in the abdominal wall, through which a portion of the colon (colostomy) or small intestine (ileostomy) is brought to the surface of the skin. This allows waste products to bypass the lower part of the digestive tract and be collected in a pouch attached to the abdomen.

A) Colostomy:

A colostomy is a surgical procedure that involves diverting a portion of the colon to an opening in the abdominal wall, called a stoma. The stoma is created by bringing the healthy end of the colon through an incision in the abdomen and attaching it to the skin. The stool then passes through the stoma into a colostomy bag or pouch, which is worn on the outside of the body.

Colostomies are typically performed for various reasons, including:

1. Bowel Obstruction: Colostomies may be done in cases where there is a blockage in the large intestine that prevents stool from passing through.

2. Inflammatory Bowel Disease: In some cases of severe ulcerative colitis or Crohn’s disease, a colostomy may be performed as a way to manage symptoms and improve quality of life.

3. Bowel Perforation or Injury: If there is a hole or injury in the colon, a colostomy may be necessary to allow it to heal without being exposed to stool.

There are different types of colostomies, including temporary and permanent ones. Temporary colostomies are created when there is a need to divert stool temporarily, such as during surgery or while waiting for an injured bowel to heal. Permanent colostomies are usually performed when there is no possibility of reconnecting the ends of the colon.

 

B) Ileostomy:

An ileostomy is a surgical procedure that involves diverting the small intestine to an opening in the abdominal wall, similar to a colostomy. The stoma is created by bringing a portion of the small intestine through an incision in the abdomen and attaching it to the skin. The waste products, including stool and digestive enzymes, then pass through the stoma into an external pouch.

Ileostomies are performed for various reasons, including:

1. Inflammatory Bowel Disease: Severe cases of ulcerative colitis or Crohn’s disease that affect the entire large intestine may require an ileostomy to manage symptoms and improve quality of life.

2. Bowel Obstruction: If there is a blockage in the small intestine that cannot be resolved through other means, an ileostomy may be necessary.

3. Familial Adenomatous Polyposis (FAP): FAP is a genetic condition characterized by the development of numerous polyps in the colon and rectum. In cases where these polyps cannot be effectively managed or removed, an ileostomy may be performed.

Similar to colostomies, ileostomies can be temporary or permanent, depending on the underlying condition and the feasibility of reconnecting the small intestine.

 

C) Advantages of Colostomy and Ileostomy:

1. Improved Quality of Life: For individuals with certain medical conditions, colostomies and ileostomies can significantly improve their quality of life by alleviating symptoms such as pain, bowel obstruction, or frequent bowel movements.

2. Disease Management: These procedures can help manage chronic conditions like inflammatory bowel disease or FAP when other treatment options have been exhausted.

3. Life-Saving: In cases of bowel perforation or injury, colostomies and ileostomies can be life-saving by allowing the bowel to heal without being exposed to stool, which can lead to infection or other complications.

 

D) Disadvantages of Colostomy and Ileostomy:

1. Psychological Impact: Adjusting to life with a colostomy or ileostomy can be challenging for some individuals, as it may affect body image, self-esteem, and social interactions.

2. Potential Complications: There are risks associated with these procedures, including infection, bleeding, stoma prolapse or retraction, hernia formation, and skin irritation around the stoma.

3. Maintenance and Care: Colostomies and ileostomies require regular maintenance and care, including emptying and changing the pouch, cleaning the stoma site, and managing potential odor or leakage issues.

In conclusion, colostomy and ileostomy are surgical management options used to divert the flow of waste products in individuals with specific medical conditions affecting the digestive system. While these procedures can significantly improve quality of life and manage certain diseases, they also come with potential psychological and physical challenges that need to be considered.

 

Complications of colostomy and ileostomy

While colostomies and ileostomies can significantly improve the quality of life for individuals with certain medical conditions, they are not without complications. Some of the potential complications associated with these procedures include:

1. Stoma Complications: The stoma is the opening created on the abdominal wall through which waste material passes into a collection bag. Stoma complications can include skin irritation, infection, and necrosis (tissue death). Skin irritation can occur due to leakage of stool or urine onto the surrounding skin, leading to redness, itching, and discomfort. Infections can develop around the stoma site, causing pain, swelling, and discharge. Necrosis of the stoma occurs when blood supply to the tissue is compromised, resulting in tissue death. This can lead to a non-functioning stoma and may require surgical intervention.

2. Bowel Obstruction: Bowel obstruction is a potential complication that can occur after colostomy or ileostomy surgery. It happens when there is a blockage in the intestines, preventing the normal passage of stool or waste material. Symptoms of bowel obstruction may include severe abdominal pain, bloating, vomiting, constipation or inability to pass gas, and a lack of appetite. Bowel obstructions can be caused by adhesions (scar tissue), hernias at the stoma site, strictures (narrowing) in the intestines, or improper placement of the stoma.

3. Dehydration and Electrolyte Imbalance: Individuals with colostomies or ileostomies may be at an increased risk of dehydration and electrolyte imbalances. This is because the colon and small intestine play a crucial role in absorbing water and electrolytes from the digestive system. With a colostomy or ileostomy, the stool bypasses a significant portion of the intestines, leading to increased fluid and electrolyte loss. Dehydration can result in symptoms such as excessive thirst, dry mouth, dark urine, fatigue, and dizziness. Electrolyte imbalances can cause muscle cramps, weakness, irregular heartbeat, and confusion.

4. Stoma Prolapse: Stoma prolapse occurs when the stoma protrudes further out of the abdomen than it should. This can happen due to weakened abdominal muscles or improper placement of the stoma during surgery. Stoma prolapse can cause discomfort, skin irritation, difficulty fitting the collection bag properly, and an increased risk of leakage. In severe cases, surgical intervention may be required to correct the prolapse.

5. Stoma Retraction: Stoma retraction is the opposite of stoma prolapse and occurs when the stoma sinks below the level of the surrounding skin. This can make it challenging to attach a collection bag securely and may lead to leakage or skin irritation. Stoma retraction can be caused by factors such as weight loss, changes in abdominal pressure, or inadequate surgical technique.

6. Psychological and Emotional Impact: Adjusting to life with a colostomy or ileostomy can have a significant psychological and emotional impact on individuals. Many people experience feelings of embarrassment, self-consciousness, or depression due to changes in body image and concerns about odor or leakage. It is essential for individuals undergoing these procedures to receive appropriate support and counseling to help them cope with these emotional challenges.

7. Dietary Changes: Following colostomy or ileostomy surgery, individuals may need to make dietary modifications to manage their condition effectively. Depending on the location of the stoma, certain foods may need to be avoided or consumed in limited quantities to prevent blockages or excessive gas production. Adjusting to a new diet can be challenging and may require guidance from a healthcare professional or a registered dietitian.

It is important to note that while these complications can occur, they are not experienced by all individuals who undergo colostomy or ileostomy surgery. The risk and severity of complications can vary depending on factors such as the individual’s overall health, the reason for the surgery, and the surgical technique used.