ILEOSTOMY
C h r o n i c
I T P
g e n e r a l l y
a f f e c t s
a d u l t s
a n d i s m
u c h m
o r e s e r i o u s . I n i t i a l t r e a t -
m e n t i s w i t h
c o r t i c o s t e r o i d d r u g s
;
i f t h i s
f a i l s , a
s p l e n e c t o m y
( s u r g i c a l r e m o v a l o f
t h e s p l e e n ) i s r e q u i r e d .
I m m u n o s u p p r e s -
s a n t d r u g s
m a y
b e
g i v e n
i f a l l
o t h e r
t r e a t m e n t f a i l s .
id o x u rid in e
A n
a n t i v i r a l d r u g
u s e d i n s k i n p r e p a r a -
t i o n s t o t r e a t t h e b l i s t e r i n g r a s h e s c a u s e d
b y
h e r p e s
s i m p l e x
a n d
h e r p e s
z o s t e r
( s h i n g l e s )
i n f e c t i o n s .
R e c e n t l y
d e v e l -
o p e d a n t i v i r a l
d r u g s ,
s u c h a s
a c i c l o v i r
,
a r e
m o r e
e f f e c t i v e
a n d i d o x u r i d i n e
i s
n o w u s e d l e s s o f t e n .
lg
T h e a b b r e v i a t i o n f o r
i m m u n o g l o b u l i n
.
Ig A n e p h ro p a th y
A k i d n e y d i s e a s e t h a t c a u s e s
h a e m a t u r i a
( p a s s a g e o f b l o o d i n t h e u r i n e ) a n d i n
w h i c h d e p o s i t s o f I g A
i m m u n o g l o b u l i n s
( c e r t a i n
p r o t e i n s
p r o d u c e d
b y
t h e
i m m u n e s y s t e m
t o c o m b a t i n f e c t i o n ) a r e
f o u n d
w i t h i n
t h e
k i d n e y s .
E x c e s s i v e
a m o u n t s
o f
I g A
a r e
s o m e t i m e s
p r o -
d u c e d i n r e s p o n s e t o a t h r o a t i n f e c t i o n .
I n s u c h c a s e s , I g A c o m
p l e x c o l l e c t s i n
t h e f i l t e r i n g
u n i t s
o f t h e k i d n e y s .
I g A
n e p h r o p a t h y i s t h e m o s t c o m
m o n f o r m
o f
g l o m e r u l o n e p h r i t i s
.
T h e c o n d i t i o n m a i n l y a f f e c t s c h i l d r e n
a n d
y o u n g
m e n .
I t
m a y
c a u s e
e i t h e r
m
i c r o s c o p i c
h a e m a t u r i a
( i n
w h i c h
b l o o d i s p a s s e d i n t h e u r i n e b u t c a n n o t
b e s e e n b y t h e n a k e d e y e )
o r e p i s o d e s
o f m a c r o s c o p i c h a e m a t u r i a
( i n w h i c h
b l o o d
c a n
b e
s e e n
i n
t h e
u r i n e ) .
I n
s o m e c a s e s ,
n e p h r o t i c s y n d r o m e
d e v e l o p s ;
i n t h i s c o n d i t i o n , l a r g e a m o u n t s o f p r o -
t e i n a r e p a s s e d i n t h e u r i n e , l e a d i n g t o
r a i s e d
b l o o d
p r e s s u r e
a n d
o e d e m a
( s w e l l i n g o f t h e t i s s u e s ) .
T r e a t m e n t
o f I g A n e p h r o p a t h y
m a y
i n v o l v e
c o r t i c o s t e r o i d d r u g s
a n d
i m m u n o -
s u p p r e s s a n t d r u g s
,
i n
a d d i t i o n
t o
t r e a t -
m e n t t o r e l i e v e a n y s y m p t o m s . O v e r a l l ,
t h e
p r o g n o s i s
f o r
I g A
n e p h r o p a t h y
i s
g o o d .
I n
s o m e c a s e s ,
h o w e v e r ,
k i d n e y
f u n c t i o n d e t e r i o r a t e s a n d , i n u p t o o n e
i n
f i v e
p e o p l e ,
k i d n e y f a i l u r e
d e v e l o p s
a f t e r m a n y y e a r s .
ile a l c o n d u it
A s e c t i o n o f t h e
i l e u m
( t h e f i n a l p a r t o f
t h e s m a l l i n t e s t i n e ) u s e d b y a s u r g e o n
t o
p r o v i d e
a
s u b s t i t u t e
c h a n n e l
f o r
u r i n e
o u t f l o w
w h e n
t h e
b l a d d e r
h a s
b e e n
r e m o v e d .
( S e e
u r i n a r y d i v e r s i o n
;
s e e a l s o
c y s t e c t o m y
. )
ile a l p o u ch
A r e s e r v o i r c o n s t r u c t e d f r o m l o o p s o f
t h e
i l e u m
( l o w e r p a r t o f t h e s m a l l i n t e s -
t i n e ) t o r e p l a c e a r e c t u m t h a t h a s b e e n
s u r g i c a l l y
r e m o v e d .
I f a n
i l e a l
p o u c h
c a n n o t b e c r e a t e d , a p e r m a n e n t
i l e o s t o -
m y
w i l l b e r e q u i r e d .
ile it is , re g io n a l
A n o u t d a t e d n a m e f o r
C r o h n ’s d i s e a s e .
ile o s to m y
A n o p e r a t i o n i n w h i c h t h e
i l e u m
( l o w e r
p a r t o f t h e s m a l l i n t e s t i n e )
i s c u t a n d
t h e e n d b r o u g h t t h r o u g h t h e a b d o m i n a l
w a l l
a n d
f o r m
e d
i n t o
a n
a r t i f i c i a l
o p e n i n g
c a l l e d a
s t o m
a
.
W
a s t e i s
d i s -
c h a r g e d
f r o m
t h e
r e m
a i n i n g
i l e u m
i n t o
a d i s p o s a b l e b a g
( s t o m a b a g )
o r
d r a i n e d i n t o a p o u c h m a d e f r o m
t h e
e n d o f t h e i l e u m a n d s i t u a t e d b e n e a t h
t h e s k i n
( a
p r o c e d u r e
c a l l e d a
c o n t i -
n e n t i l e o s t o m
y ) . I n t h e l a t t e r s i t u a t i o n ,
f a e c e s
d r a i n i n g
i n t o
t h e
p o u c h
a r e
e m p t i e d
r e g u l a r l y
t h r o u g h
a
s o f t
c a t h e t e r . A n
i l e o s t o m
y
m a y
b e
e i t h e r
p e r m
a n e n t o r t e m p o r a r y .
WHY IT IS DONE
P e r m a n e n t i l e o s t o m y i s u s u a l l y p e r f o r -
m e d
o n
p e o p l e
w h o
h a v e
s e v e r e ,
PROCEDURE FOR ILEOSTOMY
Two incisions are made in the abdominal
wall (usually on the right side): a small
circular cut for the stoma (usually sited
about 5 cm below the waist and away
from the hip bone and groin crease)
and a vertical cut to give access to the
intestine and the
m e s e n t e r y .
The site
of the stoma is discussed with the
patient prior to surgery.
the mesentery is cut to free a short length
of ileum for the stoma.
abdomen; the mesentery is then stitched to
the inner abdominalwall.
3
The main vertical incision is closed, and
the clamp is removed from the protruding
end ofthe ileum (left). This end is then turned
back and attached to the abdominal surface
with sutures (middle). When completed, it
formsa protruding spout of ileum (right).
After the intestine begins to function
normally, an ileostomy bag is fitted around
the stoma. The bag is attached to the skin
by adhesive seals.
I
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