An enterostomy is a surgical procedure that creates an artificial opening, called a stoma, from a part of the intestine through the abdominal wall. This opening allows for the diversion of digestive waste, which collects in an external pouching system worn on the abdomen. The procedure is performed when the normal pathway for waste elimination is compromised due to disease, injury, or other medical issues. The enterostomy allows the bowel to heal or provides a necessary alternative route for waste to exit the body.
Defining Different Types of Intestinal Openings
Enterostomy broadly covers different procedures, primarily categorized by the section of the intestine used to form the stoma. The two most common types are the colostomy and the ileostomy, with the anatomical location determining the consistency and nature of the output. A colostomy is created from the large intestine (colon) and is typically situated on the left side of the abdomen. Because the colon absorbs water, the waste diverted through a colostomy is generally more solid and formed, particularly if the stoma is located closer to the rectum.
An ileostomy is formed from the ileum, the final section of the small intestine, and is usually placed on the lower right side of the abdomen. Since the waste bypasses the colon, less water is absorbed, resulting in output that is more liquid or paste-like and frequent. The output is rich in digestive enzymes, making it corrosive to the skin around the stoma (peristomal skin). Ileostomy patients require stricter attention to skin barrier protection compared to colostomy patients. A third, less common type, a jejunostomy, is created higher up in the small intestine and yields a very high volume of liquid output, increasing the risk of dehydration and electrolyte imbalances.
Conditions Requiring the Procedure
An enterostomy becomes necessary to treat conditions that damage the bowel or obstruct the normal passage of waste. Inflammatory Bowel Diseases (IBD), specifically Crohn’s disease and Ulcerative Colitis, often require the procedure to allow the diseased section of the bowel to rest and heal or because that section has been surgically removed. Cancer of the colon or rectum may necessitate an enterostomy, particularly if the tumor causes an obstruction or requires the removal of lower structures.
Other indications include diverticulitis, where inflamed pouches in the colon can perforate or cause blockages. Intestinal trauma, such as from an accident, may require immediate diversion to manage the damage and prevent infection. In pediatric cases, birth defects like imperforate anus or conditions like necrotizing enterocolitis can also require an enterostomy. The diversion is often created to protect a newly created surgical connection further down the bowel or to bypass a segment that is too damaged or inflamed to function safely.
Surgical Process and Recovery
The creation of an enterostomy involves bringing a segment of the intestine through a measured incision in the abdominal wall. The end of the intestine is rolled back on itself, much like a shirt cuff, and stitched to the skin to form the stoma, which is designed to protrude slightly for easier pouching. Surgeons determine the best location for the stoma pre-operatively, often with the help of an ostomy nurse, ensuring the patient can see and manage the appliance.
There are two main configurations: an end stoma and a loop stoma. An end stoma is created when the bowel below the stoma is either removed or permanently separated, with only one opening brought to the surface; this is often a permanent procedure. A loop stoma involves bringing a loop of the intestine through the abdomen and making an incision in the exposed loop, resulting in two openings: one for stool and one for mucus. Loop stomas are typically temporary, allowing the downstream bowel to rest and heal before a reversal surgery reconnects the bowel ends. Immediate recovery involves a hospital stay, during which patients work closely with specialized nurses to learn stoma care fundamentals, including how to empty and change the collection pouch.
Living with an Enterostomy
Daily life with an enterostomy centers on managing the pouching system, which collects the waste and adheres to the skin around the stoma. The system consists of a skin barrier (wafer) that sticks to the abdomen, and a collection pouch; these are available as a one-piece or two-piece system. The pouch must be emptied when it is about one-third to one-half full to prevent it from becoming too heavy and pulling away from the skin barrier.
Maintaining the health of the peristomal skin is essential, especially for ileostomy patients, as the liquid, enzymatic output can cause irritation. Proper skin barriers and protective sprays or wipes are used to create a seal and protect the skin from waste exposure. Odor and gas management are addressed through odor-proof pouches and filters integrated into the appliance. Dietary adjustments are often necessary, focusing on hydration, particularly for those with an ileostomy.
Patients are advised to drink extra fluids and may need to consume oral rehydration solutions to prevent dehydration. Physical activity and most normal daily routines can be resumed once recovery is complete, often utilizing supportive belts or specialized clothing to secure the appliance during exercise.