• Enterostomy

    Definition

    This is surgery that involves the abdominal wall and intestines. An opening is made into the intestines to drain the contents out or put in a feeding tube. There are many different types of enterostomies. One example is a jejunostomy. This is when an opening is made in the jejunum, a section of the small intestines.
    The Intestines
    The Intestines
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    This surgery is done when a new exit for intestinal or fecal matter is needed. It may be needed when feces can no longer travel all the way through the bowels and out the anus.
    An enterostomy may also be needed when food can no longer enter the mouth or stomach normally. In this case, a feeding tube will be placed to help food enter the intestines.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have enterostomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Blood clots
    • Infection
    • Skin irritation around the stoma from leaking digestive fluids
    • Diarrhea
    • Intestinal obstruction
    • Hernia at surgical site
    • Blockage or leakage of the tube, requiring replacement
    • Adverse reaction to the anesthesia
    Some factors that may increase the risk of complications include:
    • Smoking
    • Bleeding or clotting disorders
    • Active infection
    • Lung or heart disease
    Be sure to discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, such as warfarin (Coumadin)
      • Clopidogrel (Plavix)
    • Your intestines will be cleaned out with a special solution.
    • Your doctor will talk to you about the physical and emotional difficulties that you will face after this surgery.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    There are different ways this surgery can be done. In one technique, an intestinal sac for collecting fecal waste will be created inside of the abdomen. This sac will include a stoma (hole) in the abdominal wall. The stoma allows access to the sac so that it can be emptied (through a tube.) In another technique, the intestine will be directly attached to the abdominal wall so that an external bag can be attached to collect fecal waste.
    If the surgery is done to place a feeding tube, an incision will be made in your abdominal wall. The doctor will grasp a section of your small intestine. A small opening will be made. The tube will be placed through this opening and secured in place with sutures. The tube will then be brought through your abdominal wall. It will be secured with sutures.
    These procedures may be done by an:

    How Long Will It Take?

    • 30-45 minutes to insert the tube
    • 2-4 hours if sections of the intestine need to be removed

    How Much Will It Hurt?

    You will have soreness and tenderness after the procedure. Ask your doctor about medicine to help with the pain.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 2-4 days. Your doctor may choose to keep you longer, however, if complications arise.

    Post-procedure Care

    At the Hospital
    • You may need antibiotics. You may also need medicine for nausea and pain.
    • If you had an enterostomy to help fecal matter exit the bowels, you may have a pouch on the outside of your body. Waste material will be collected in it. You will receive instructions about diet and activity. During the first few days after surgery, you may be restricted from eating.
    • The staff will monitor your fluid intake and output (due to the risk of dehydration ).
    • You will wear boots or special socks to help prevent blood clots.
    • You will be asked to walk often after surgery.
    • You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will improve lung function.
    • Your incision will be examined often for signs of infection.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • You will need to practice good skin care of the area around the stoma. This will help to prevent inflammation and infection.
    • Be sure to follow your doctor’s instructions .
    • You will need to take it easy for 1-2 months.
    • A specialized nurse will teach you how to care for the stoma site and change the ostomy bag if you have one.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the stoma site
    • Pus or yellow/green discharge from the incision
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Signs of infection, including fever and chills
    • Severe abdominal pain
    • Cough, shortness of breath, or chest pain
    • Pain and/or swelling in your feet, calves, or legs
    • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
    • Blood in your stool, or black, tarry stools
    • Diarrhea
    • If you had a feeding tube placed, food cannot pass through the tube
    • The tube comes out or leaks
    • If you had an ostomy bag placed, and there is no stool collecting in the bag.
    In case of an emergency, call for medical help right away.

    RESOURCES

    Family Doctor.org http://familydoctor.org/

    National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/index.htm/

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology http://www.cag-acg.org/

    Canadian Digestive Health Foundation http://www.cdhf.ca/index.html/

    References

    Enterostomy. Health-Cares website. Available at: http://digestive-disorders.health-cares.net/enterostomy.php . Updated July 18, 2005. Accessed September 1, 2009.

    Gastroenterology urology devices. US Food and Drug Administration website. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?FR=876.5980 . Published April 1, 2008. Accessed September 1, 2009.

    Shellito PC, Malt RA. Tube gastrostomy. Techniques and complications. Ann Surg. 1985;201:180-185.

    Torosian MH, Rombeau JL. Feeding by tube enterostomy. Surg Gynecol Obstet. 1980;150:918-927.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    HeartSHAPE® Test Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.