continent ileostomy


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Related to continent ileostomy: ileoanal reservoir, continent urostomy

ileostomy

 [il″e-os´tah-me]
an artificial opening (stoma) created in the ileum and brought to the surface of the abdomen for the purpose of evacuating feces. This may be done in the treatment of ulcerative colitis, crohn's disease, congenital defects of the bowel, cancer, trauma, and other conditions requiring bypass of the colon.

An ileostomy may be temporary or permanent. When the ileostomy is done in conjunction with partial or complete removal of the colon and anus, it is always permanent. The stoma created by ileostomy usually is located in the right lower quadrant of the abdomen.
Patient Care. Patients with an ileostomy require physical care similar to that given patients with a colostomy. The major difference is that the fecal material from an ileostomy will be more liquid and the passage of feces through the stoma less predictable than in a colostomy. The farther along the intestinal tract a stoma is located, the firmer the stool.

The psychosocial impact of surgery for either urinary or fecal diversion is a major concern of patients and their professional caregivers, families, and significant others. The problems related to this kind of surgery and the changes it brings in self-concept and fulfillment of roles are shared by all patients who must live with a stoma. Hence the emotional and psychological care of these patients is presented under stoma.

The appliance for collection of feces is worn continuously and emptied every 4 to 5 hours. There is a continuous flow of liquid feces through an ileostomy. There should be no problem with persistent odor if the appliance is well made, worn correctly, and washed and rinsed frequently. Manufacturers of collection devices provide detailed information about cleaning and storage of their products.

Obstruction and diarrhea are common problems to be avoided. In regard to obstruction, the major offenders are foods that absorb water, for example, hard nuts, dried fruits, corn (including popcorn), and foods high in fiber. Particles from these foods are not small enough to pass through the ileostomy stoma; hence they inhibit the passage of feces and produce abdominal cramping and vomiting. Relief of blockage requires oral administration of enzymes to promote digestion, gentle lavage, and massage of the abdomen to encourage passage of the obstructing material. As a last resort, surgery may be necessary to remove the obstruction. Laxatives are never given; they will only aggravate the problem. Patients are taught the symptoms of obstruction and the necessity of consulting a health care professional should they occur and self-care measures not be effective.

Diarrhea is a more frequent problem in patients with an ileostomy than in patients with other types of fecal diversion and it is more likely to result in fluid and electrolyte imbalance than it would in a person who defecates normally. Although the fecal material passing through an ileostomy is already semi-liquid, patients can learn the difference between what is normal for them and what is indicative of diarrhea.

Dietary restrictions, other than the foods that could cause an obstruction, are not severe. The ostomate usually begins with a bland diet and gradually adds foods one at a time, noting whether a particular food causes problems of flatus, abdominal cramps, or diarrhea. Patients are warned that eating too quickly, not chewing food thoroughly, and swallowing air while eating can contribute to the problem of flatulence.
continent ileostomy an ileostomy that maintains continence of feces, usually through construction of a continent ileal reservoir; the ileostomy must be drained by the patient several times a day. See also kock pouch.
Continent ileostomy (Kock pouch) with Maclet ring device. 1, Loop of terminal ileum is sutured together and cut open. Using forceps, surgeon intussescepts distal ileum to form nipple valve. 2, Free edges sutured together to form reservoir; stoma sutured flush with skin, and pouch sutured to abdominal wall. 3, Magnetic ring is implanted in subcutaneous layer and stoma closed with magnetic cap. From Polaski and Tatro, 1996.
urinary ileostomy ileal conduit.

continent ileostomy

[kon′tinənt]
an ileostomy that drains into a surgically created pouch or reservoir in the abdomen. Involuntary discharge of intestinal contents is prevented by a nipple valve created from the ileum. This method eliminates the need for the patient to wear an external pouch over the stoma. Also called Kock's pouch.
method After surgery the pouch is kept relatively empty by means of a catheter placed in it at surgery. The catheter is removed a week or two afterward, depending on the status of intestinal function and wound healing. Once the indwelling catheter is removed, the pouch is drained by periodically inserting a catheter through the stoma into the pouch through the valve. The time allowed to elapse between catheterizations is gradually lengthened as the capacity of the pouch increases to between 500 and 1000 mL. Six months after surgery drainage may be necessary only three or four times a day. The patient learns to recognize a feeling of fullness that indicates the need for drainage. When the patient is seated on the toilet, the dressing over the stoma is removed, and the tip of a French size 28 to 32 catheter is lubricated and inserted into the stoma. The distal end of the catheter is in a receptacle or in the toilet, at least 30 cm below the stoma. The lubricated tip of the catheter is advanced carefully through the stoma. Resistance is usually felt at a depth of about 5 cm where the valve covers the opening to the pouch. Flow usually begins when the tip of the catheter has passed the valve, at a distance of approximately 7.5 cm from the stoma. Complete drainage may require up to 15 minutes.
interventions After surgery the patient is usually instructed to add foods one at a time. High-fiber foods and those that cause gas formation are particularly likely to be problematic. Thick secretions may be thinned by the injection of a little water into the pouch through the catheter. The stoma may be covered with a stoma cap or dressing. It is important to teach the patient to prevent irritation of the skin around the stoma. Nonallergenic tape may be used to hold the pad in place. After healing, if there is no danger of a blow to the abdomen, a pad is often not necessary. After surgery activity is resumed as the patient is able to tolerate it. There is no reason for activity to be curtailed once healing is complete and the person feels well.
outcome criteria The patient may expect to be able to care for the stoma and to manage the drainage of the pouch. A continent ileostomy has several advantages, including the prevention of unpleasant odors and the convenience of eliminating the need for a colostomy or ileostomy bag.
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Surgical formation of a continent ileostomy
References in periodicals archive ?
In fact, I just did a continent ileostomy this week.
SerVaas: So the continent ileostomy is usually for those who don't have rectal tissue left.
Schiller also lectures on the History of Ileostomy Surgery, the Kock pouch continent ileostomy, and Surgical Options for Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease).