Potential Problems After Surgery

Many people are concerned about the longevity of their jpouch. How long will it last? What types of complications might potentially occur? Here is a link to an excellent site that gives you really good in-depth and objective info on the Potential Problems Following J-Pouch Surgery

Image to the left shows the large intestine and rectum removed, the formation of the temporary ileostomy, and the jpouch. The whole series of photos can be found by clicking on the following jpouch.org link.

Ileostomy Health Article

Illustrations
An ileostomy can be placed ...

An ileostomy can be placed in different sites on the abdomen (A). Once the incision is made, the ileum is pulled through the incision (B), and a rod is placed under the loop. The loop is cut open, one side is stitched to the abdomen (C). The portion of intestine is flipped open to expose the interior surface (D), and the opposite side is stitched in place (E). (Illustration by GGS Inc.)

Ileostomy Health Article Part-2

An ileostomy can be placed ..

Aftercare

Following surgery, the patient is instructed in the care of the stoma, placement of the ileostomy bag, and necessary changes to diet and lifestyle. Because the large intestine (a site of fluid absorption) is no longer a part of the patient's digestive system, fecal matter exiting the stoma has a high water content. The patient must therefore be diligent about his or her fluid intake to minimize the risk of dehydration. Visits with an enterostomal therapist (ET) or a support group for individuals with ostomies may be recommended to help the patient adjust to living with a stoma. Once the ileostomy has healed, a normal diet can usually be resumed, and the patient can return to normal activities.

Risks

Risks associated with the ileostomy procedure include excessive bleeding, infection, and complications due to general anesthesia. After surgery, some patients experience stomal obstruction (blockage), inflammation of the ileum, stomal prolapse (protrusion of the ileum through the stoma), or irritation of the skin around the stoma.

Normal results

The physical quality of life of most patients is not affected by an ileostomy, and with proper care most patients can avoid major medical complications. Patients with a permanent ileostomy, however, may suffer emotional aftereffects and benefit from psychotherapy.

Morbidity and mortality rates

Among patients who have undergone a Brooke ileostomy, medical literature reports a 19–70% risk of complications. Small bowel obstruction occurs in 15% of patients; 30% have problems with the stoma; 20–25% require further surgery to repair the stoma; and 30% experience postsurgical infections. The rate of complications is also high among patients who have had a continent ileostomy (15–60%). The most common complications associated with this procedure are small bowel obstruction (7%), wound complications (35%), and failure to restore continence (50%). The mortality rate of both procedures is less than 1%.

Alternatives

Patients with mild to moderate ulcerative colitis may be able to manage their disease with medications. Medications that are given to treat ulcerative colitis include enemas containing hydrocortisone or mesalamine; oral sulfasalazine or olsalazine; oral corticosteroids; or cyclosporine and other drugs that affect the immune system.

A surgical alternative to ileostomy is the ileal pouch-anal anastomosis, or ileoanal anastomosis. This procedure, used more frequently than permanent ileostomy in the treatment of ulcerative colitis, is similar to a continent ileostomy in that an ileal pouch is formed. The pouch, however, is not attached to a stoma but to the anal canal. This procedure allows the patient to retain fecal continence. An ileoanal anastomosis usually requires the placement of a temporary ileostomy for two to three months to give the connected tissues time to heal.

BOOKS

"Inflammatory Bowel Diseases: Ulcerative Colitis." In The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

Pemberton, John H., and Sidney F. Phillips. "Ileostomy and Its Alternatives" (Chapter 105). In Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 7th ed. Philadelphia: Elsevier Science, 2002.

Rolandelli, Rolando H., and Joel J. Roslyn. "Colon and Rectum," (Chapter 46), In Sabiston Textbook of Surgery. Philadelphia: W. B. Saunders Company, 2001.

PERIODICALS

Allison, Stephen, and Marvin L. Corman. "Intestinal Stomas in Crohn's Disease." Surgical Clinics of North America 81, no. 1 (February 1, 2001): 185-95.

ORGANIZATIONS

Crohn's and Colitis Foundation of America. 386 Park Ave. S., 17th Floor, New York, NY 10016. (800) 932-2423. .

United Ostomy Association, Inc. 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. (800) 826-0826. .

OTHER

Hurst, Roger D. "Surgical Treatment of Ulcerative Colitis." [cited May 1, 2003]. .

Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

---

Ileostomies are usually performed in a hospital operating room. The surgery may be performed by a general surgeon, a colorectal surgeon (a medical doctor who focuses on diseases of the colon, rectum, and anus), or gastrointestinal surgeon (a medical doctor who focuses on diseases of the gastrointestinal system).

QUESTIONS TO ASK THE DOCTOR

---

• Why is an ileostomy being recommended?
• What type of ileostomy would work best for me?
• What are the risks and complications associated with the recommended procedure?
• Are any nonsurgical treatment alternatives available?
• How soon after surgery may I resume my normal diet and activities?

Page: <> 1 2

Ileostomy Health Article Part-1

An ileostomy can be placed ...

Definition

An ileostomy is a surgical procedure in which the small intestine is attached to the abdominal wall in order to bypass the large intestine; digestive waste then exits the body through an artificial opening called a stoma (from the Greek word for "mouth").

Purpose

In general, an ostomy is the surgical creation of an opening from an internal structure to the outside of the body. An ileostomy, therefore, creates a temporary or permanent opening between the ileum (the portion of the small intestine that empties to the large intestine) and the abdominal wall. The colon and/or rectum may be removed or bypassed. A temporary ileostomy may be recommended for patients undergoing bowel surgery (e.g., removal of a segment of bowel), to provide the intestines with sufficient time to heal without the stress of normal digestion.

Chronic ulcerative colitis is an example of a medical condition that is treated with the removal of the large intestine. Ulcerative colitis occurs when the body's immune system attacks the cells in the lining of the large intestine, resulting in inflammation and tissue damage. Patients with ulcerative colitis often experience pain, frequent bowel movements, bloody stools, and loss of appetite. An ileostomy is a treatment option for patients who do not respond to medical or dietary therapies for ulcerative colitis.

Other conditions that may be treated with an ileostomy include:

• bowel obstructions
• cancer of the colon and/or rectum
• Crohn's disease (chronic inflammation of the intestines)
• congenital bowel defects
• uncontrolled bleeding from the large intestine
• injury to the intestinal tract

Demographics

The United Ostomy Association estimates that approximately 75,000 ostomy surgeries are performed each year in the United States, and that 750,000 Americans have an ostomy. Ulcerative colitis and Crohn's disease affect approximately one million Americans. There is a greater incidence of the diseases among Caucasians under the age of 30 or between the ages of 50 and 70.

Description

For some patients, an ileostomy is preceded by removal of the colon (colonectomy) or the colon and rectum (protocolectomy). After the patient is placed under general anesthesia, an incision approximately 8 in (20 cm) long is made down the patient's midline, through the abdominal skin, muscle, and other subcutaneous tissues. Once the abdominal cavity has been opened, the colon and rectum are isolated and removed. The anal canal is stitched closed. Other patients undergoing ileostomy will have only a temporary bypass of the colon and rectum; examples are patients undergoing small bowel resection or the creation of an ileoanal anastomosis. An ileoanal anastomosis is a procedure in which the surgeon forms a pouch out of tissue from the ileum and connects it directly to the anal canal.

There are two basic types of permanent ileostomy: conventional and continent. A conventional ileostomy, also called a Brooke ileostomy, involves a separate, smaller incision through the abdominal wall skin (usually on the lower right side) to which the cut end of the ileum is sutured. The ileum may protrude from the skin, often as far as 2 in (5 cm). Patients with this type of stoma are considered fecal-incontinent, meaning they can no longer control the emptying of wastes from the body. After a conventional ileostomy, the patient is fitted with a plastic bag worn over the stoma and attached to the abdominal skin with adhesive. The ileostomy bag collects waste as it exits from the body.

An alternative to conventional ileostomy is the continent ileostomy. Also called a Kock ileostomy, this procedure allows a patient to control when waste exits the stoma. Portions of the small intestine are used to form a pouch and valve; these are directly attached to the abdominal wall skin to form a stoma. Waste collects internally in the pouch and is expelled by insertion of a soft, flexible tube through the stoma several times a day.

Diagnosis/Preparation

The patient meets with the operating physician prior to surgery to discuss the details of the surgery and receive instructions on pre- and post-operative care. Directly preceding surgery, an intravenous (IV) line is placed to administer fluid and medications, and the patient is given a bowel prep to cleanse the bowel and prepare it for surgery. The location where the stoma will be placed is marked, away from bones, abdominal folds, and scars.

Page: 1 2 Next >

Via: http://www.healthline.com

Pictures of stoma

Let’s start with the beginning.

This is a picture of an unprotected stoma opening:

…

…

The following is a picture of a double stoma, the poor guy really looks beaten up.

…

…

How a stoma bag looks on you. As you can see, it can easily be hidden below the clothes and one can continue having a normal life, he/she just needs to be a little more carefull. Here’s the picture:

…

…

An important thing to be careful about when you have to take care of a stoma, you need to watch closely how the skin looks like around the stoma. For example, it is good to look like this :

…

…

On the other hand, if the skin around the stoma looks like the next picture for more than two pouch changes, you should check with your doctor as soon as possible:

…

…

And one last picture for you, this is a more like a sketch and it represents a stoma resulting from a descending colostomy

Via: http://stomastomata.com

Stoma - Ileostomy and Urostomy what they are

First have in mind that a doctor and a nurse will guide you though this whole process and you are not alone in this so be confident and all will be all right in the end.

Ileostomy is a stoma constructed by bringing the small intestine( ileum) to the surface of the skin. This way, the waste is collected in a pouch on the abdomen. This kind of stoma is situated on the right side of the abdomen. When an injury occurs on the large intestine and the colon is removed an ileostomy is vitally necessary. Diseases which need surgical removal include „Crohn’s disease” , „Ulcerative colitis” , „Familial adenomatous polyposis” etc. Ileostomy sometimes is necessary in colorectal cancer treatment . A temporary ileostomy is necessary when a tumor blocks the colon. A loop of intestines are brought out through a stoma and the colon and rectum will be removed. This kind of stoma are often the first step in reconstruction of an ileo-anal pouch. This can last up to 11 weeks.

How one lives with an ileostomy

They need an ostomy pouch that collects all intestinal waste. This is a dreinable pouch that is leakproffed at the bottom and it can be used to get rid of the waste any time. It is clearly better that a permanent pouch that needs to be replaced when it gets full. This kind of stoma implies that the pouch will be emptied 4-5 time a day, everyday. So simply it can be used whenever they find themselves near a bathroom. Every 3-6 days the pouch will become deteriorated and needs to be changed and it is rather hard to notice when worn under the clothes, unless it gets too full.

To minimize your problems or a potential blockage one should chew the food very very good in order to help with the digestion process. Also some foods are not recommended like potatoes and some raw vegetables because they are harder to digest.

Alternatives

There is an alternative that needs no external pouch (because that can be for some very unpleasant) named ileo-anal pouch. An internal reservoir is connected to the anus made from the ileum after removing the colon and rectum. So there is no need for external „devices”.

Urostomy

The 4 most commonly reasons when one needs a urostomy:

1. bladder cancer
2. neurological dysfunction of the bladder (the bladder doesn’t work as it should)
3. birth defects
4. chronic inflammation of the bladder

The urostomy is another form of stoma. It is used for the urinary system. When there are problems with the bladder or the urethra and urinating can not be done by natural ways there is need of a urestomy. The process is rather similar to the Ileostomy. An artificial bladder is made of a bowl that can be emptied whenever it is necessary. This process is not that complicated as an ileostomy and it is simply a procedure to detour urine away from the problem and the organs which suffered surgical procedures and need time to heal. Sometimes the bladder is removed making the urine pass through the stoma to get outside of the body. The surgery that is done to extract and get rid of the sickened bladder is named CYSTECTOMY.

Via: http://stomastomata.com

Stoma care - types of stoma and problems that might occur

The name of the stoma comes from the intestine that forms the opening. Here are some different stoma:

1. colostomy, an opening from the large bowel, to allow feces to bypass the anus.

2. ileostomy, an opening from the small bowel, to allow feces to leave the body without passing through the large bowel

3. urostomy,an artificial connection between the urinary tract (the kidneys, bladder and tubes that connect them) and the abdominal wall

4. jejunostomy, an opening from the first part of the small bowel, also used for feeding

5. gastrostomy, an opening from the skin directly into the stomach, to allow feeding

Stoma care is very important and there are a few problems that people having this condition may encounter. The most important problem of having a stoma is the psychological one. Some people just find it very hard to know they have a stoma and get shy or just sad because they feel different or ugly in some way. That is a stupid thing to even consider so do not act childish about this! There are specialists and special trained nurses that can take you throughout this entire process and you can find the best comfort in their professionalism. They do help a lot. A good idea is to surf the internet and find others who suffer from stoma and learn from them how to deal with your problem, and how to take care about your stoma.

Another problem when having stoma is the smell. This is the reason that you start changing you diet and start learning what is best to eat and what you should avoid. Fish and eggs and beer can cause excess wind and runny motions. Try to keep a healthy and rich diet every day because it is very important in your recovery.

If you must travel by plain be sure not to consume fizzy drinks before you get on the plane. Due to the change in pressure in the aircraft cabin, this can cause the stoma bag to simply come off. This would be just terrible so if you can, avoid by all means traveling by air.

Another common problem is taking care of the skin around the stoma. It can easily become sore and broken so ask the doctor about ways of taking care of that or just go to a local pharmacy and ask the pharmacist. He or she most certainly can give you a lotion which has skin care properties, and will help you feel more comfortable.

There are also a rage of different bags and hypoallergenic protective skin barriers and creams that can help you. Here are some medicine that are related to helping with the treatment, but take then jut as a „heard about” matter and don’t use these medication before asking a doctor about them.

I heard the following help:

1. Ispaghula husk – help in constipation

2. Magnesium hydroxide – also helps in constipation

3. Loperamide – helps in diarrhea

4. Kaolin and morphine - help in diarrhea

5. Codeine phosphate - increases the amount of water absorbed resulting in more solid feces

Many people live now a healthy worry-free life after recovering from this disease and you can too. You can fully recover from this!!! Just learn a few about your problem and be an optimistic and courageous spirit. I wish you success!

Changing a stoma pouch

I have just found a little video with someone that is demonstrating how to change your stoma bag. It shows you how to change a one piece stoma bag and how to change a two piece stoma bag. It is nicely demonstrated, so if in need check this out.

Via: http://stomastomata.com