A loop ileostomy is a surgical procedure that creates a temporary opening, or stoma, in the abdomen to divert waste from the digestive tract. This opening is formed from the ileum, the final section of the small intestine. It is most often a temporary measure designed to allow the downstream bowel to rest and heal before intestinal continuity is restored in a second operation.
The primary purpose of creating a loop ileostomy is to divert the flow of stool away from a vulnerable area of the lower bowel, such as a recent surgical connection. This protective diversion ensures that waste does not pass over a fresh wound, significantly lowering the risk of complications like an anastomotic leak. The procedure involves bringing a loop of the small intestine out through the abdominal wall, which gives the operation its name and distinct structure.
Medical Conditions Requiring the Procedure
The need for a temporary diverting loop ileostomy most commonly arises following complex colorectal surgery. When a surgeon removes a diseased section of the colon or rectum and rejoins the remaining ends, the new connection is called an anastomosis. A diverting ileostomy is frequently placed upstream to protect this delicate surgical join, allowing it time to heal without exposure to stool.
The procedure is also utilized in cases of severe inflammation or injury that require temporary relief for the distal bowel. Conditions like complicated diverticulitis or severe inflammatory bowel disease may necessitate diversion to calm inflamed tissue and prevent further infection or perforation. A temporary stoma can also manage the flow of waste following traumatic injury to the colon or rectum, allowing the damaged tissue to recover. The ileostomy is typically reversed once the underlying medical issue is resolved and the lower bowel has adequately healed.
How the Loop Ileostomy is Constructed
A loop ileostomy involves bringing a section of the small intestine (ileum) out through a single incision in the abdominal wall. The surgeon selects a loop of the ileum, usually on the right side of the abdomen, and pulls it through a small, surgically created opening. This exteriorized loop is then partially opened and stitched to the skin’s surface to create the stoma.
This construction results in two distinct openings, or lumens, within the single stoma. The proximal opening, closer to the stomach, is the active stoma that passes stool into an external pouching system. The distal opening leads to the portion of the bowel that is temporarily out of use and typically passes only a small amount of mucus. A temporary plastic rod or bridge was traditionally placed underneath the loop to provide support and prevent the stoma from retracting back into the abdomen.
Daily Management and Stoma Care
Living with a loop ileostomy requires diligent care focused on the appliance and managing the high-volume output from the small intestine. Since the stoma lacks a muscular sphincter, the person has no control over when stool or gas passes, necessitating the continuous use of an external pouching system. The pouch consists of a bag and an adhesive skin barrier (wafer). It must be emptied several times a day when it is about one-third to one-half full to prevent it from becoming too heavy or leaking.
Protecting the skin around the stoma, known as peristomal skin, is important because the output from the ileum contains highly irritating digestive enzymes. The opening in the adhesive wafer must be sized correctly to fit closely around the stoma, preventing effluent from contacting the skin. Changing the entire pouching system is typically done two to three times a week, or immediately if burning, itching, or wetness is felt under the barrier, signaling a potential leak.
A primary concern for ileostomy management is the risk of dehydration and electrolyte imbalance. Because the large intestine, which normally absorbs water and salt, is bypassed, the ileostomy output is liquid or paste-like and occurs continuously. Normal output volume ranges from 500 to 800 milliliters per 24 hours, and exceeding this can quickly lead to fluid loss. Maintaining hydration requires a consistent intake of fluids and often the addition of salt or electrolyte solutions to replace those lost.
Dietary adjustments are necessary to prevent a stoma blockage, which can occur if high-fiber foods are not chewed thoroughly. Foods such as nuts, seeds, popcorn, and raw vegetables can clump together and cause an obstruction, leading to abdominal cramping, swelling, and a lack of output. Patients are encouraged to introduce foods gradually and observe their individual tolerance to maintain a balanced diet.
The Ileostomy Reversal Process
The reversal of a loop ileostomy is a planned surgical procedure that marks the end of the diversion. This operation is generally considered less complex than the initial creation of the stoma and is typically scheduled once the underlying bowel has fully healed, often between eight weeks and six months later. This timing allows for complete recovery and the completion of any necessary post-operative treatments.
During the reversal, the surgeon makes an incision around the stoma site to free the loop of the small intestine from the abdominal wall. The two openings of the ileum (proximal and distal limbs) are detached from the skin and rejoined to restore the continuity of the digestive tract. This reconnected section of the bowel, called an anastomosis, is then placed back inside the abdomen, and the skin incision is closed.
The goal is to allow stool to once again pass through the entire small and large intestine, eliminating the need for the external pouching system. Patients usually remain in the hospital until their bowel function returns, which is often characterized by frequent, loose bowel movements initially. While the body adapts over time, it can take several months for a more settled and predictable bowel pattern to establish itself.