Total surprise is sometimes the reaction of a patient when a physician recommends an ileostomy.  While many people are aware that this procedure is major surgery, few are familiar with the reasons why colorectal surgeons perform it or with any surgical alternatives available.

What Exactly Are Ileostomies?

They are procedures in which a colorectal surgeon directs the ileum—the end of the small bowel—through an opening in the abdomen called a stoma.  This permits waste to exit the body through a bag or appliance affixed to the patient’s skin using adhesive products, according to BCIRhistory.com.

Ileostomies are required after removal of the entire colon (large intestine), called a colectomy.  The type of ostomy recommended depends in part on whether the surgeon also removes the rectum in a proctocolectomy.  In some cases, ileostomies are temporary measures used to rest an inflamed or injured colon.

Reasons to Recommend the Surgery

Surgeons perform ileostomies for a wide variety of reasons, NHS Choices reports:

• Crohn’s disease is an incurable inflammatory bowel disease (IBD) often managed with both medication and surgery.  Some patients might require temporary or permanent ileostomies.

• Ulcerative colitis is a second type of IBD.  Removing the colon can cure the disease.  Doctors also sometimes recommend removal when severe inflammation does not respond to medication.

• Bowel cancer that arises inside the rectum or the large intestine could necessitate removal of the colon and/or rectum.

• Familial adenomatous polyposis is a rare disorder resulting in the formation of non-malignant tissue lumps in the colon.  Because a majority of patients eventually develop bowel cancer, removing the colon is a standard recommendation.

• Bowel obstructions that completely block the colon can make temporary or permanent ileostomies necessary.

• Injuries like punctures and impacts can permanently damage the colon, requiring its removal, or necessitate a temporary surgical diversion.

Surgical Options

With removal of the colon and/or rectum, patients have several options when it comes to permanent or temporary ileostomies, MedlinePlus reports:

• Traditional surgeries are also known as Brooke ileostomies.  The surgeon brings the end of the small bowel through a stoma.  Waste collects in a bag.

• Pull-through procedures are appropriate for some patients with an intact rectum, to which the surgeon attaches the end of the small bowel.

• Continent ileostomies allow the individual more convenience than traditional ileostomies do.  A patient periodically drains an internal pouch through a valve.  The newest type, the Barnett Continent Intestinal Reservoir (BCIR), has an improved design that gives patients more control, BCIRhistory.com reports.  As a result, many individuals now want older ileostomies converted to BCIRs.

For Crohn’s patients whose colons must be removed, permanent ileostomies are the only alternative, according to the Crohn’s & Colitis Foundation of America.  This is because they face such high risks for complications like relapses, abscesses, fistulas, and strictures that could interfere with the proper functioning of an internal pouch.