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Ileosto-what...?

Many of you know that on April 15th of 2014 I had my first of two surgeries for my ulcerative colitis. In this first surgery, my colon was removed, a j-pouch was created and I was given a temporary ileostomy. Some of you know what an ostomy is, but many of you do not know and even fewer of you know what an ileostomy is exactly.

There are different types of ostomies. Colostomies are ostomies that involve the colon. Urostomies are ostomies that involve the ureters. Ileostomies involve the small intestine (specifically the ileum).

 So, I'm here to tell you all you need to know about an ileostomy! Basically an ileostomy is a surgical opening constructed by pulling the small intestine through the abdominal wall. This is done for various reasons. Mine was done because my colon was so inflamed it had to be removed. The colon is located at the end of the digestive tract. It absorbs water and nutrients in the final stages of digestion. When the colon is removed, the waste your body produces has to exit another way. This is where the ileostomy comes in.

 Normally, ileostomies are located to the right of your belly button (see illustrations below). The red "button-like" bit of intestine that comes through the skin is called the stoma (from the Greek word "mouth"). This is where the waste exits the body. A bag (which is normally glued to the skin surrounding the stoma - see fig. d) is attached to the body to collect said waste.
 

How the ileostomy is created: After the patient is put under anesthesia, an incision is made down the midline of the abdomen, through the skin, muscle and other subcutaneous tissues. Once the colon and rectum are removed, another smaller incision is made in the abdominal wall (usually to the right of the navel). There, the small intestine is pulled through the opening to create an ileostomy.There are two main types of ileostomies: the loop and the end. 

 A loop ileostomy is created by the ileum being pulled through the smaller incision (fig. e). A rod is then placed beneath the loop and the loop is cut open (fig. f). One side is stitched to the abdomen. A portion of the intestine is then flipped open to expose the interior surface and the opposite side is stitched in place (fig. g & h). The hole closest to the navel (in my case anyway) is just beneath the surface of the skin and sometimes expels a bit of mucous. The hole located away from the navel expels waste. During my first surgery, the surgeon removed my colon and created my j-pouch (see fig. c above). This can also be done in two separate surgeries. 


An end ileostomy is created when the end of the ileum is pulled through the smaller incision (fig. i). The end is then flipped inside out to expose the interior surface and then sewn in place (fig. j). It can protrude up to 2 inches outside the body. I have never had an end ileostomy as my surgeon created my j-pouch during my first surgery. During my second surgery he is going to sew up my small intestine, poke it back down into my abdomen, and then sew me shut. This surgery is far less invasive and from what I hear the recovery time is much better as well.

The final surgery in the whole ileal-anal pouch anastomosis is supposedly one of the most difficult psychologically. This is simply because when your bowels start working again, it can feel like your Ulcerative Colitis is flaring up. I'm hoping and praying that I will be strong and try not to freak out about everything. 

So there you have it. The explanation of an ileostomy. I hope all of this made sense. If not, please feel free to ask me any questions. You can email me (see the link to the right), find me on Facebook or Twitter. Or you can just leave a comment below. 

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