Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy

What Is Bowel Diversion Surgery?

Bowel diversion surgery allows stool to safely leave the body when (because of disease or injury) the large intestine is removed or needs time to heal. Bowel is a general term for any part of the small or large intestine.

Some bowel diversion surgeries (those called ostomy surgery) divert the bowel to an opening in the abdomen where a stoma is created. A surgeon forms a stoma by rolling the bowel's end back on itself, like a shirt cuff, and stitching it to the abdominal wall. An ostomy pouch is attached to the stoma and worn outside the body to collect stool. Other bowel diversion surgeries reconfigure the intestines after damaged portions are removed. For example, after removing the colon, a surgeon can create a colon like pouch out of the last part of the small intestine, avoiding the need for an ostomy pouch.

Possible reasons for bowel diversion surgery:

• Cancer,
• Trauma,
• Inflammatory bowel disease (IBD),
• Dowel obstruction, and
• Diverticulitis

Which Parts of the Gastrointestinal Tract Are Affected by Bowel Diversion Surgeries?

Bowel diversion surgeries affect the large intestine and often the small intestine

• Small Intestine

The small intestine runs from the stomach to the large intestine and has three main sections:

• The duodenum, which is the first 10 inches;
• Tthe jejunum, which is the middle 8 feet; and
• The ileum, which is the final 12 feet.

Bowel diversion surgeries only affect the ileum.

• Large Intestine

The large intestine is about 5 feet long and runs from the small intestine to the anus.

The two main sections of the large intestine are:

• The colon and
• Rectum.

Semisolid digestive waste enters the colon from the small intestine. Gradually, the colon absorbs moisture and forms stool as digestive waste moves toward the rectum. The rectum is about 6 inches long and is located right before the anus. The rectum stores stool, which leaves the body through the anus. The rectum and anus control bowel movements.

What are the different types of bowel diversion surgery?

Several surgical options exist for bowel diversion.

• Ileostomy diverts the ileum to a stoma. Semisolid waste flows out of the stoma and collects in an ostomy pouch, which must be emptied several times a day. An ileostomy bypasses the colon, rectum, and anus and has the fewest complications.
• Colostomy is similar to an ileostomy, but the colon (not the ileum) is diverted to a stoma. As with an ileostomy, stool collects in an ostomy pouch.
• Ileoanal reservoir surgery is an option when the large intestine is removed but the anus remains intact and disease-free. The surgeon creates a colon like pouch, called an ileoanal reservoir, from the last several inches of the ileum. The ileoanal reservoir is also called a pelvic pouch or J-pouch. Stool collects in the ileoanal reservoir and then exits the body through the anus during a bowel movement. People who have undergone ileoanal reservoir surgery initially have about six to 10 bowel movements a day. Two or more surgeries are usually required, including a temporary ileostomy, and an adjustment period lasting several months is needed for the newly formed ileoanal reservoir to stretch and adjust to its new function. After the adjustment period, bowel movements decrease to as few as 4 to 6 a day.
• Continent ileostomy is an option for people who are not good candidates for ileoanal reservoir surgery because of damage to the rectum or anus but do not want to wear an ostomy pouch. As with ileoanal reservoir surgery, the large intestine is removed and a colon-like pouch, called a Kock pouch, is made from the end of the ileum. The surgeon connects the Kock pouch to a stoma. A Kock pouch must be drained each day by inserting a tube through the stoma. An ostomy pouch is not needed and the stoma is covered by a patch when it is not in use.

Some people only need a temporary bowel diversion; others need permanent bowel diversion.

Which bowel diversion surgery is appropriate?

Important factors in determining most appropriate surgery:

• Type,
• Degree,
• Location of bowel damage, and
• Personal preference

For example, people whose disease affects the ileum are poor candidates for ileoanal reservoir surgery or continent ileostomy because of the increased risk of disease recurrence and the need for pouch removal.

Discussing treatment options with a doctor and seeking the advice of an ostomy nurse (specialist who cares for people with bowel diversions) is highly advocated.

Concerns Related to Bowel Diversion

Although bowel diversion surgery can bring great relief, many people fear the practical, social, and psychological issues related to bowel diversion. An ostomy nurse is trained to help patients deal with these issues both before and after surgery.

Bowel Diversion Surgery at a Glance

• Bowel diversion surgery allows stool to safely leave the body when (because of disease or injury) the large intestine is removed or needs time to heal.
• Bowel is a general term for any portion of the small or large intestine.
• The type, degree, and location of bowel damage, and personal preference, are all factors in determining which bowel diversion surgery is most appropriate.
• An ostomy nurse can help patients deal with the practical, social, and psychological issues related to bowel diversion.