Enterostomy

Pronounced: en-tuh-ROS-stuh-mee
by Diana Kohnle

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
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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    TOP

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    TOP

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    TOP

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/online/famdocen/home.html
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.accessd... . 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 http://www.ebscohost.com/dynamed/ : 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.
Last reviewed December 2011 by Daus Mahnke, MD
Last Updated: 12/30/2011