What is Loop Ileostomy

Loop ileostomy is a procedure to permanently or temporarily redirect part of the small intestine (ileum) to an external opening (stoma) in the abdomen. This means that waste passes through the stoma and into an external bag (ostomy pouch), instead of passing through the rest of the intestines and the rectum (bowel). This procedure may be done when the bowel is diseased or partially removed. A loop ileostomy is usually temporary. It may be reversed later during another procedure.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Skin irritation around the stoma.
• Narrowing or collapsing of the stoma.
• Blockage of the intestine (ileus).
• Tissue bulging through a weak spot in the muscles of the abdomen (hernia).
• Part of the small intestine coming out through the stoma (prolapse).
• Difficulty absorbing nutrients from foods.
• Loss of fluid in the body (dehydration).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking medicine to clean out your intestines (bowel prep). Take this medicine as told by your health care provider.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• Do not use tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
• Your health care provider will mark or identify your surgical site. He or she will make sure that the area will be easy for you to care for.
• You will have a physical exam, which may include a rectal exam.
• You may have tests, such as:
  • Blood tests.
  • Stool tests.
  • X-rays.
  • Colonoscopy.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Taking antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or both of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A drainage tube may be passed through your nose and into your stomach (NG tube, or nasogastric tube).
• An incision will be made in your abdomen.
• An incision will be made in part of your ileum to create an opening.
• A loop of small intestine is pulled through the incision.
• The opening in your ileum will be turned inside out and then attached to your abdomen with stitches (sutures) to make the stoma.
• An ostomy pouch will be attached around your stoma.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV.
• The NG tube will be removed.
• You may not be able to drink fluids normally or eat solid food until at least 24 hours after your procedure. You may be given ice chips to suck on until you are able to drink fluids normally.
• You will be taught how to care for your stoma and how to use the ostomy pouch.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may need to have some medicines changed after the procedure. Certain medicines are absorbed differently with an ileostomy.
• Do not drive for 24 hours if you received a sedative.

Summary

• Loop ileostomy is a procedure to permanently or temporarily redirect part of the small intestine (ileum) to an external opening (stoma) in the abdomen.
• Generally, this is a safe procedure. However, problems may occur, including bleeding, infection, damage to other organs, or difficulty absorbing nutrients from food.
• Stay hydrated before and after your procedure. Follow eating or drinking restrictions as told by your health care provider.
• Your health care provider will instruct you about changing or stopping medicines before the procedure. Some medicines may need to be changed after the procedure because certain medicines are absorbed differently with an ileostomy.
• After the procedure, you will be monitored closely for any problems. You will continue to receive fluids and medicines from an IV. Afterward you will be taught how to care for your stoma and how to use the ostomy pouch.

Loop Ileostomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• A dark-colored, swollen, and bruised stoma.
• A small amount of blood or clear fluid draining from your stoma or rectum.
• Pain and discomfort in your abdomen, especially around your stoma. You will be given medicines to help relieve the pain.
• Irregular bowel movements for several days.
• Loose stools. The stools will gradually become firmer and more regular.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Your health care provider may change some medicines after the procedure. Certain medicines are absorbed differently with an ileostomy.

Stoma care

• Follow instructions from your health care provider about how to take care of your stoman. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing) or care for your stoma. If soap and water are not available, use hand sanitizer.
  • Change your dressing or ostomy pouch as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. In some cases, these skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips entirely unless your health care provider tells you to remove them.
• Check your stoma and the area around the stoma every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Pus or a bad smell.
  • Warmth.
• Keep your stoma and the surrounding area clean and dry.
• Do not take baths, swim, or use a hot tub until your health care provider says it is okay to do so.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Pay attention to which foods and drinks cause problems, such as gas, constipation, or diarrhea.
• Avoid spicy foods and caffeine while your stoma heals.
• Eat meals and snacks at regular intervals.
• Drink enough fluid to keep your urine pale yellow.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Rest as much as possible while your stoma heals.
• Avoid intense physical activity for as long as you are told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg) for 6 weeks, or for as long as you are told by your health care provider.

Driving

• Do not drive for 24 hours if you received a sedative.
• Do not drive or operate heavy machinery while taking prescription pain medicine.

General instructions

• Follow your health care provider’s instructions about changing and cleaning your ostomy pouch.
• Keep supplies to care for your stoma and ostomy pouch with you at all times.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
• If you are a woman and are planning to become pregnant, or are taking birth control pills, discuss this with your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your stoma.
• You have more fluid or blood coming from your stoma.
• Your stoma feels warm to the touch.
• You have pus or a bad smell coming from your stoma.
• You have a fever.
• You have loose stools that do not get firmer after several weeks.
• You have bowel movements more or less often than is expected by your health care provider.
• You have nausea or you vomit.
• You have pain in the abdomen, bloating, pressure, or cramping.
• You have problems with sexual activity.
• You feel very tired (fatigue).
• You are unusually thirsty or you always have a dry mouth.
• You are having trouble keeping your ostomy pouch on for less than 2 days.

Get help right away if:

• You feel dizzy or lightheaded.
• Your pain or cramps in the abdomen get worse, or do not go away when you take medicine.
• Your stoma suddenly changes size or color.
• You have shortness of breath.
• You have bleeding from your stoma that does not stop.
• You vomit more than once.
• You faint.
• You have internal tissue bulging out of your stoma (prolapse).
• You have an irregular heartbeat.
• You have chest pain.

Summary

• After your procedure, there may be a small amount of blood or clear fluid leaking from your stoma or rectum. You may also have pain and loose stools. You will be given medicine for pain. Loose stools will become firmer and more regular over time.
• Take all medicines as told by your health care provider. Some medicines may be change because of the ileostomy.
• Your health care provider will instruct you about caring for your ileostomy. You will also be told about any activity and eating and drinking restrictions.
• If you have problems or questions, about your loop ileostomy, contact your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.