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Ostomy Surgery of the Bowel Ostomy Surgery of the Bowel National Digestive Diseases Information Clearinghouse What is ostomy surgery of the bowel? Ostomy surgery of the bowel, also known as bowel diversion, refers to surgical procedures that reroute the normal movement of Esophagus intestinal contents out of the body when Mouth part of the bowel is diseased or removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that waste exits through the abdominal wall instead of passing through the anus. Stomach Ostomy surgery of the bowel may be Duodenum temporary or permanent, depending on the reason for the surgery. A surgeon specially Colon trained in intestinal surgery performs the Small procedure in a hospital. During the surgery, intestine the person receives general anesthesia. Jejunum Ileum Ostomy surgeries of the bowel include Rectum • ileostomy Cecum Anus • colostomy Appendix • ileoanal reservoir The normal GI tract • continent ileostomy intestine, and anus. The small intestine What is the bowel? measures about 20 feet long in adults and The bowel is another word for the small and includes large intestines. The bowel forms the largest • the duodenum––the first part of the part of the gastrointestinal (GI) tract—a small intestine nearest the stomach series of hollow organs joined in a long, twisting tube from the mouth to the anus. • the jejunum––the middle section of the The anus is a 1-inch-long opening through small intestine between the duodenum which stool leaves the body. Organs that and ileum make up the GI tract include the mouth, • the ileum––the lower end of the small esophagus, stomach, small intestine, large intestine Peristalsis––a wavelike movement of muscles Why does a person need in the GI tract––moves food and liquid through the GI tract. Peristalsis, along with ostomy surgery of the bowel? the release of hormones and enzymes, helps A person may need ostomy surgery of the food digest. The small intestine absorbs bowel if he or she has nutrients from foods and liquids passed • cancer of the colon or rectum from the stomach. Most food digestion and nutrient absorption take place in the small • an injury to the small or large intestine intestine. • inflammatory bowel disease––long- The large intestine consists of the cecum, lasting disorders, such as Crohn’s colon, and rectum. The cecum connects to disease and ulcerative colitis, that cause the last part of the ileum and contains the irritation or sores in the GI tract appendix. The large intestine measures • obstruction––a blockage in the bowel about 5 feet in adults and absorbs water that prevents the flow of fluids or solids and any remaining nutrients from partially digested food passed from the small • diverticulitis––a condition that occurs intestine. The large intestine then changes when small pouches in the colon waste from liquid to semisolid or solid feces, called diverticula become inflamed, or or stool. Stool passes from the colon to the irritated and swollen, and infected rectum. The rectum measures 6 to 8 inches Read more in these publications at www. in adults and is located between the last part digestive.niddk.nih.gov: of the colon and the anus. The rectum stores • Crohn’s Disease stool prior to a bowel movement. During a bowel movement, stool moves from the • Diverticular Disease rectum, through the anus, and out of the • Ulcerative Colitis body. • What I need to know about Crohn’s Read more in The Digestive System and How Disease It Works at www.digestive.niddk.nih.gov. • What I need to know about Diverticular Disease 2 Ostomy Surgery of the Bowel What is a stoma? What is an ileostomy? During ostomy surgery of the bowel, a An ileostomy is a stoma created from a part surgeon creates a stoma by bringing the end of the ileum. For this surgery, the surgeon of the intestine through an opening in the brings the ileum through the abdominal abdomen and attaching it to the skin to create wall to make a stoma. An ileostomy may an opening outside the body. A stoma may be permanent or temporary. An ileostomy be three-fourths of an inch to a little less than is permanent when the surgeon removes 2 inches wide. The stoma is usually located in or bypasses the entire colon, rectum, and the lower part of the abdomen, just below the anus. A surgeon may perform a temporary beltline. However, sometimes the stoma is ileostomy for a damaged or an inflamed located in the upper abdomen. The surgeon colon or rectum that only needs time to rest and a wound, ostomy, and continence (WOC) or heal from injury or surgery. After the nurse or an enterostomal therapist will work colon or rectum heals, the surgeon repairs together to select the best location for the the opening in the abdominal wall and stoma. A removable external collection reconnects the ileum so stool will pass into pouch, called an ostomy pouch or ostomy the colon normally. An ileostomy is the appliance, is attached to the stoma and worn most common temporary bowel diversion. outside the body to collect intestinal contents A surgeon performs an ileostomy most often or stool. Intestinal contents or stool passes to treat inflammatory bowel disease or rectal through the stoma instead of passing through cancer. the anus. The stoma has no muscle, so it Read more about rectal cancer at www. cannot control the flow of stool, and the flow cancer.gov/cancertopics/types/colon-and-rectal. occurs whenever peristalsis occurs. Ileostomy and colostomy are the two main types of ostomy surgery of the bowel during which a surgeon creates a stoma. Stoma Colon Ileum An ostomy pouch Anus Rectum Ileostomy 3 Ostomy Surgery of the Bowel What is a colostomy? What is an ileoanal reservoir? A colostomy is a stoma created from a part An ileoanal reservoir is an internal pouch of the colon. For this surgery, the surgeon made from the ileum. This surgery is a brings the colon through the abdominal common alternative to an ileostomy and does wall and makes a stoma. A colostomy not have a permanent stoma. Also known as a may be temporary or permanent. The J-pouch or pelvic pouch, the ileoanal reservoir colostomy is permanent when the surgeon connects to the anus after a surgeon removes removes or bypasses the lower end of the the colon and rectum. Stool collects in the colon or rectum. A surgeon may perform a ileoanal reservoir and then exits the body temporary colostomy for a damaged or an through the anus during a bowel movement. inflamed lower part of the colon or rectum An ileoanal reservoir is an option after that only needs time to rest or heal from removal of the entire large intestine when the injury or surgery. Once the colon or rectum anus remains intact and disease-free. The heals, the surgeon repairs the opening in the surgeon often makes a temporary ileostomy abdominal wall and reconnects the colon so before or at the time of making an ileoanal stool will pass normally. A surgeon performs reservoir. Once the ileoanal reservoir heals a colostomy most often to treat rectal cancer, from surgery, the surgeon reconnects the diverticulitis, or fecal incontinence––the ileum to the ileoanal pouch and closes the accidental loss of stool. temporary ileostomy. A person does not need a permanent external ostomy pouch for an Read more in Fecal Incontinence at www. ileoanal reservoir. digestive.niddk.nih.gov. A surgeon creates an ileoanal reservoir most often to treat ulcerative colitis or familial adenomatous polyposis. Familial Small intestine adenomatous polyposis is an inherited disease characterized by the presence of 100 or more Colon polyps in the colon. The polyps may lead to colorectal cancer if not treated. People with Stoma Colon section Colon (removed) (removed) Anus Rectum (may be removed) Ileum Colostomy Ileoanal reservoir Anus Ileoanal reservoir 4 Ostomy Surgery of the Bowel Crohn’s disease usually are not candidates for continent ileostomy is now uncommon, and this procedure. most hospitals do not have a specialist who knows how to perform this type of surgery. As Read more in What I need to know about with ileoanal reservoir surgery, the surgeon Colon Polyps at www.digestive.niddk.nih.gov. usually removes the colon and rectum to treat the original bowel disease, such as ulcerative What is a continent colitis or familial adenomatous polyposis. ileostomy? People with Crohn’s disease are not usually candidates for this procedure. A continent ileostomy is an internal pouch, sometimes called a Kock pouch, fashioned from the end of the ileum just before it exits What are the complications the abdominal wall as an ileostomy. The of ostomy surgery of the surgeon makes a valve inside the pouch so that intestinal contents do not flow out. The bowel? person drains the pouch each day by inserting Complications of ostomy surgery of the a thin, flexible tube, called a catheter, through bowel may include the stoma. The person covers the stoma • skin irritation with a simple patch or dressing. A continent ileostomy is an option for people who are • stoma problems not good candidates for an ileoanal reservoir • blockage because of damage to the rectum or anus and who do not want to wear an ostomy pouch. • diarrhea • bleeding Creating the Kock pouch is a delicate surgical procedure that requires a healthy bowel • electrolyte imbalance for proper healing. Therefore, a surgeon • infection usually does not perform Kock pouch surgery during an acute attack of bowel disease. A • irritation of the internal pouch, or pouchitis • vitamin B12 deficiency • phantom rectum • short bowel syndrome Colon (removed) • rectal discharge Skin Irritation Ileum Skin irritation is the most common complication for people with an ostomy.
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