A continent ileostomy is a surgical procedure where a patient's ileum, the connection between the large and small bowel, is severed to address bowel cancer or another problem in the bowel. Instead of creating an opening through the abdomen to allow the ileum drain directly into a collection pouch, the surgeon creates an internal pouch so the patient can drain feces as needed. This procedure is an alternative to the traditional ileostomy, where the patient will have to manage a fecal collection pouch after surgery, and may experience discomfort and social anxiety as a result.
Ileostomies are recommended when the bowel is so badly damaged that either a segment needs to be removed, or it needs to be completely rested to allow it to recover. Common causes can include cancers, severe inflammation, or trauma to the bowel. In a continent ileostomy, the surgeon creates an artificial pouch inside the abdomen and connects the ileum to a stoma covered with a patch when it is not in use.
Fecal material is collected in the internal pouch and the patient can control the expression of feces by inserting a catheter into the stoma when the pouch fills. The pouch inside the abdomen will hold the contents tightly sealed until the patient removes the patch and inserts a lubricated catheter. The continent ileostomy patient can use the bathroom when the need for a bowel movement develops and will not need to manage an external collection pouch.
A continent ileostomy procedure may be proposed as an option when procedures involving the connection of the severed section of ileum to the anus and rectum are not possible due to tissue damage, infection, and other issues. It eliminates some of the problems associated with a regular ostomy procedure. The patient will not develop skin irritation associated with having to tape or strap the collection bag in place. Usually, patients can resume normal physical activity after surgery as well.
When a surgeon recommends the continent ileostomy, the patient may want to ask about available alternatives, and the risks and benefits of the various options. This can help patients reach informed decisions about their medical care. Potential risks of this procedure include abdominal infection, both around the pouch and the stoma, along with adverse reactions to anesthesia. Patients will also need to receive training in how to care for the surgical site and how to manage the drainage of the internal pouch with a catheter.