Digestive Diseases A-Z List of Topics and Titles :Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy

Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy

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What is bowel diversion surgery?

Bowel diversion surgery allows stool to safely leave the body when—because of disease or injury—the large intestine is removed or needs time to heal. Bowel is a general term for any part of the small or large intestine.

Some bowel diversion surgeries—those called ostomy surgery—divert the bowel to an opening in the abdomen where a stoma is created. A surgeon forms a stoma by rolling the bowel’s end back on itself, like a shirt cuff, and stitching it to the abdominal wall. An ostomy pouch is attached to the stoma and worn outside the body to collect stool.

Other bowel diversion surgeries reconfigure the intestines after damaged portions are removed. For example, after removing the colon, a surgeon can create a colonlike pouch out of the last part of the small intestine, avoiding the need for an ostomy pouch.

Cancer, trauma, inflammatory bowel disease (IBD), bowel obstruction, and diverticulitis are all possible reasons for bowel diversion surgery.

Drawing of a stoma with the stoma and the abdomen labeled.

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Which parts of the gastrointestinal tract are affected by bowel diversion surgeries?

Bowel diversion surgeries affect the large intestine and often the small intestine.

Small Intestine

The small intestine runs from the stomach to the large intestine and has three main sections: the duodenum, which is the first 10 inches; the jejunum, which is the middle 8 feet; and the ileum, which is the final 12 feet. Bowel diversion surgeries only affect the ileum.

Drawing of the digestive tract with the appendix, esophagus, pancreas, liver, stomach, small intestine, large intestine, rectum, and anus labeled.
Bowel diversion surgeries affect the large intestine and often the small intestine.

Large Intestine

The large intestine is about 5 feet long and runs from the small intestine to the anus. The colon and rectum are the two main sections of the large intestine. Semisolid digestive waste enters the colon from the small intestine. Gradually, the colon absorbs moisture and forms stool as digestive waste moves toward the rectum. The rectum is about 6 inches long and is located right before the anus. The rectum stores stool, which leaves the body through the anus. The rectum and anus control bowel movements.

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What are the different types of bowel diversion surgery?

Several surgical options exist for bowel diversion.

  • Ileostomy diverts the ileum to a stoma. Semisolid waste flows out of the stoma and collects in an ostomy pouch, which must be emptied several times a day. An ileostomy bypasses the colon, rectum, and anus and has the fewest complications.

  • Colostomy is similar to an ileostomy, but the colon—not the ileum—is diverted to a stoma. As with an ileostomy, stool collects in an ostomy pouch.

  • Ileoanal reservoir surgery is an option when the large intestine is removed but the anus remains intact and disease-free. The surgeon creates a colonlike pouch, called an ileoanal reservoir, from the last several inches of the ileum. The ileoanal reservoir is also called a pelvic pouch or J-pouch. Stool collects in the ileoanal reservoir and then exits the body through the anus during a bowel movement. People who have undergone ileoanal reservoir surgery initially have about six to 10 bowel movements a day. Two or more surgeries are usually required, including a temporary ileostomy, and an adjustment period lasting several months is needed for the newly formed ileoanal reservoir to stretch and adjust to its new function. After the adjustment period, bowel movements decrease to as few as 4 to 6 a day.

  • Continent ileostomy is an option for people who are not good candidates for ileoanal reservoir surgery because of damage to the rectum or anus but do not want to wear an ostomy pouch. As with ileoanal reservoir surgery, the large intestine is removed and a colon-like pouch, called a Kock pouch, is made from the end of the ileum. The surgeon connects the Kock pouch to a stoma. A Kock pouch must be drained each day by inserting a tube through the stoma. An ostomy pouch is not needed and the stoma is covered by a patch when it is not in use.

Some people only need a temporary bowel diversion; others need permanent bowel diversion.

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Which bowel diversion surgery is appropriate?

The type, degree, and location of bowel damage, and personal preference, are all factors in determining which surgery is most appropriate. For example, people whose disease affects the ileum are poor candidates for ileoanal reservoir surgery or continent ileostomy because of the increased risk of disease recurrence and the need for pouch removal.

Discussing treatment options with a doctor and seeking the advice of an ostomy nurse—a specialist who cares for people with bowel diversions—are highly recommended.

Drawings of a normal bowel and three types of bowel diversion surgeries, including ileostomy/colostomy, ileoanal reservoir, and continent ileostomy. The normal bowel drawing shows the stomach, small intestine, and large intestine. The ileostomy/colostomy drawing shows the stomach and a shortened small intestine that ends at a stoma. It also shows the large intestine, which is shaded to indicate it has been removed or bypassed during surgery. The stoma is labeled. The ileoanal reservoir surgery drawing shows the stomach and a shortened small intestine whose end has been turned into an ileoanal reservoir. It also shows the large intestine, which has been shaded to indicate it has been removed or bypassed during surgery. The anus and ileoanal reservoir are labeled. The continent ileostomy drawing shows the stomach and a shortened small intestine whose end has been turned into a Kock pouch. It also shows the large intestine, which is shaded to indicate it has been removed or bypassed during surgery. A short segment of bowel protrudes from the Kock pouch and ends at a stoma. The Kock pouch and stoma are labeled.

Bowel diversion surgeries. D

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Concerns Related to Bowel Diversion

Although bowel diversion surgery can bring great relief, many people fear the practical, social, and psychological issues related to bowel diversion. An ostomy nurse is trained to help patients deal with these issues both before and after surgery. People living with an ostomy or who need bowel diversion surgery may also find useful advice and information through local or online support groups.

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Points to Remember

  • Bowel diversion surgery allows stool to safely leave the body when—because of disease or injury—the large intestine is removed or needs time to heal.

  • Bowel is a general term for any portion of the small or large intestine.

  • The type, degree, and location of bowel damage, and personal preference, are all factors in determining which bowel diversion surgery is most appropriate.

  • An ostomy nurse can help patients deal with the practical, social, and psychological issues related to bowel diversion.

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Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases conducts and supports basic and clinical research into many digestive disorders, including inflammatory bowel disease and diverticular disease.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

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For More Information

Cancer Information Service
National Cancer Institute
NCI Public Inquiries Office
6116 Executive Boulevard, Room 3036A
Bethesda, MD 20892–8322
Phone: 1–800–4–CANCER (422–6237)
TTY: 1–800–332–8615
Internet: www.cancer.gov/cis

Crohn’s & Colitis Foundation of America
386 Park Avenue South, 17th Floor
New York, NY 10016
Phone: 1–800–932–2423 or 212–685–3440
Fax: 212–779–4098
Email: info@ccfa.org
Internet: www.ccfa.org

United Ostomy Associations of America, Inc.
P.O. Box 66
Fairview, TN 37062
Phone: 1–800–826–0826 or 615–799–2990
Fax: 615–799–5915
Email: info@uoaa.org
Internet: www.uoaa.org

Wound, Ostomy and Continence Nurses Society
15000 Commerce Parkway, Suite C
Mount Laurel, NJ 08054
Phone: 1–888–224–WOCN (9626)
Email: wocn_info@wocn.org
Internet: www.wocn.org

The National Digestive Diseases Information Clearinghouse collects resource information about digestive diseases for the NIDDK Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources.

You may view the results of the automatic search on bowel diversion surgeries: ileostomy, colostomy, ileoanal reservoir, and continent ileostomy. If you wish to perform your own search of the database, go to NIDDK Reference Collection.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (463–6332) or visit www.fda.gov. Consult your doctor for more information.

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National Digestive Diseases Information Clearinghouse

2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Victor W. Fazio, M.D., chairman, Department of Colorectal Surgery, Cleveland Clinic Foundation, and Linda K. Aukett, advocacy chair, United Ostomy Associations of America, Inc.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 09–4641
February 2009

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