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. Cancer, trauma, inflammatory bowel disease (IBD), bowel obstruction, and diverticulitis are all possible reasons for bowel diversion surgery.
The bowel is a general term for any portion of the small or large intestine. Small intestine runs from the stomach to the large intestine and has three main sections: the duodenum (first 10 inches), the jejunum (middle 8 feet) and ileum (final 12 feet) which only affect bowel diversion surgery.
The Large intestine is about 5 feet long and runs from the small intestine to the anus. Two main sections of large intestine are the colon and 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.
The type, degree, and location of bowel damage, and personal preference are all factors in determining which bowel diversion surgery is most appropriate.
- 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 –Similar to an ileostomy (stool collects in an ostomy pouch), but the colon (not the ileum) is diverted to a stoma.
- Ileoanal reservoir surgery – An option when the large intestine is removed but the anus remains intact and disease-free. The surgeon creates a colon like a pouch (an ileoanal reservoir) from the last several inches of the ileum where the stool collects and then exits the body through the anus during a bowel movement. People initially have about six to 10 bowel movements a day but after two or more surgeries, including a temporary ileostomy and an adjustment period lasting several months, it decreases to as few as 4 to 6 a day.
- Continent ileostomy – 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. The large intestine is removed and a colon-like pouch (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 so 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.
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.