Types of ileostomies
Standard Ileostomy
(Brooke Ileostomy)
Standard Ileostomy
(Brooke Ileostomy)
Continent Ileostomy
(Kock Pouch)
Ileoanal Reservoir
(J-Pouch)
Ileostomy
An ileostomy is formed from the ileum (the last part of the small intestine). It diverts waste away from the colon, which may be removed or not functioning properly. Ileostomies are typically permanent.
The conditions that can require an ileostomy include certain illnesses, injuries, or other problems with your digestive tract, including:
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Ulcerative colitis
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Crohn’s disease
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Trauma
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Multiple polyps in colon and rectum
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Carcinoma
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Obstruction
Standard Ileostomy
(Brooke Ileostomy)
A standard ileostomy, often referred to as a Brooke ileostomy, involves bringing the end of the ileum through the abdominal wall to create a stoma. This procedure is typically performed when the colon is removed or bypassed.
Indications
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Inflammatory Bowel Disease: Commonly performed for conditions such as ulcerative colitis and Crohn's disease.
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Familial Adenomatous Polyposis (FAP): A hereditary condition that leads to numerous polyps in the colon, often necessitating removal of the colon.
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Colon Cancer: When a significant portion of the colon is removed due to cancer.
Surgical Technique
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The surgery can be performed using an open approach or laparoscopically.
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The surgeon removes the colon and rectum and brings the ileum through a small incision in the abdominal wall to form a stoma.
Stoma Location
The stoma is usually located in the right lower quadrant of the abdomen.
Output
Stoma output is typically a continuous, liquid or paste-like drainage containing digestive enzymes, as it bypasses the colon, which would normally absorb water from stool.
Pouching System
Patients wear an external pouching system that collects waste continuously. These pouches are designed to be discreet and can be easily hidden under clothing.
How Does It Work?
Surgical Creation
During surgery, part of the ileum is looped back on itself to form a pouch. A valve is also created using a segment of the ileum, which acts like a door to keep waste inside the pouch until it’s time to drain it.
Pouch Functionality
The pouch collects stool and mucus from the intestines. Patients can drain the contents by inserting a thin tube called a catheter into the valve when they feel the urge to empty it. This usually needs to be done several times a day.
No External Pouch Required
One of the biggest advantages of a continent ileostomy is that patients do not have to wear an external bag or pouch all the time.
Continent Ileostomy
(Kock Pouch)
It’s made by looping part of the ileum back on itself so that a reservoir or pocket is formed inside the belly (abdomen). A nipple valve is made from part of the ileum. A few times each day you put in a thin, soft tube called a catheter to drain the waste out of the reservoir inside your belly.
Unlike traditional ileostomies, which require an external pouch to collect waste, a continent ileostomy allows patients to manage their waste internally, providing greater control and comfort.
Output
The output from an ileoanal reservoir can vary widely but generally consists of soft, formed stool. Over time, as patients adapt their diets and their bodies adjust, the consistency may improve.
Pouching system
There is no external pouch required; instead, patients insert a catheter into the valve of the internal pouch to drain waste. This allows for more discretion and flexibility in managing bowel movements.
Ileoanal Reservoir
(J-Pouch)
The ileoanal reservoir, often referred to as a J-pouch or pelvic pouch surgery, involves creating an internal pouch from the ileum that is connected directly to the anus. This allows for more normal bowel function while preserving anal function.
Pouching System
While patients do not need an external pouch, they must be mindful of skin care around the anus to prevent irritation or breakdown due to frequent stool passage
Pouching Creation
The ileum is fashioned into a J-shaped reservoir that stores stool before it is expelled through the anus. However, an individual cannot use the pouch right after surgery as it requires healing. Therefore, a temporary ileostomy is conducted to allow diversion of waste, once the J-pouch is healed there is closure of the ileostomy (the ileum is again attached to the pouch). When an “urge” is felt, the stool is passed through the anus, out of the body. The sphincter muscle around the anal opening must be intact to keep the pouch from leaking. The consistency of the output of the pelvic pouch depends on what you eat and drink and may be managed with medicines.
Output
The output from an ileoanal reservoir can vary widely but generally consists of soft, formed stool. Over time, as patients adapt their diets and their bodies adjust, the consistency may improve.
Output
The output from an ileoanal reservoir can vary widely but generally consists of soft, formed stool. Over time, as patients adapt their diets and their bodies adjust, the consistency may improve.
Indications
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Primarily indicated for patients with ulcerative colitis or familial adenomatous polyposis who desire to maintain anal function after colon removal.
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Ideal for those who are motivated to manage their bowel habits without an external pouch.
Surgical Technique
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First Surgery: The colon and rectum are removed; an ileostomy is created temporarily while healing occurs.
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Second Surgery: After several months (usually 8–12 weeks), a second surgery reconnects the ileal pouch to the anus, allowing stool passage through normal anal function.