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An ileostomy is a procedure in which the lumen of the ileum, part of the small bowel, is brought through the abdominal wall via a surgically-created opening called a stoma. The purpose of an ileostomy is to evacuate stool from the body via the ileum instead of the usual route via the anus. This activity reviews the indications, contraindications, and potential benefits of the ileostomy and highlights the role of the interprofessional team in the management of patients with a stoma. Objectives: Describe the indications for an ileostomy. Outline the contraindications to ileostomy. Review the technique involved in creating an ileostomy. Explain the importance of enhancing care coordination among interprofessional team members to improve outcomes for patients undergoing ileostomy. Access free multiple choice questions on this topic.

An ileostomy is when the lumen of the ileum (small bowel) is brought through the abdominal wall via a surgical opening (created by an operation). This can either be temporary or permanent, an end or a loop. The purpose of an ileostomy is to evacuate stool from the body via the ileum rather than the usual route of the anus. The output from an ileostomy consists of loose or porridge-like stool consistent with that expected to pass through the small bowel (as it is the large bowel that is responsible for making the stool more solid dependent upon water absorption). The output from an ileostomy can vary but typically ranges from 200 to 700 ml per day, and an Ileostomy is typically formed on the right side of the abdomen.

These can be classified as immediate, early or late or as procedure specific and general complications. It is important to note that complications following the creation of an intestinal stoma are experienced by 20% of the patients. General complications vary depending on the type of operation being undertaken for an ileostomy to be necessary. Procedure-specific complications include the following [4]: Stenosis Ischemia/Necrosis Hemorrhage Infection/Abscess A parastomal hernia Retraction/Prolapse Electrolyte imbalance due to the high output of the effluent from the ileostomy Dehydration Renal impairment Hematoma/Seroma Obstruction Fistula formation Skin irritation

While an ileostomy is usually done by a general surgeon, pediatric surgeon or a colorectal surgeon, the management of the ileostomy is by a stoma nurse. Ileostomy formation can be a result of either emergency or elective surgery. It is important that in both situations, the risk of formation and its implications are discussed in detail. Key personnel involved in this process include the surgeon who has the responsibility of consenting the patient regarding the details of the procedure as well as the post-operative course involved. The stoma nurses are very helpful in helping to identify where the ileostomy is best placed as well as in stoma education and psychological support. During the operation, other key members include the scrub nurse and the surgical assistant where appropriate. It is important to seek a mental health consultant for patients with an ileostomy, because many patients do not fully realize what it entails. [9][10][11](Level V)