Common Conditions Leading to Ileostomy Surgery

There are two main conditions that can require removal of the entire colon (large intestine) and rectum leading to an ileostomy. These are Ulcerative Colitis and Familial Adenomatous Polyposis.

Ulcerative Colitis (UC) is an inflammatory condition that affects only the large intestine (never the small intestine). The cause is unknown despite much research, but it is felt that there is a combination of genetic and environmental factors. UC primarily affects young people (teens and early 20s). It causes frequent urgent bowel movements (10-20 per day) with bleeding. Many medical treatments are available, but not everyone responds. Surgery is required for hemorrhage, perforation, or when the disease becomes intractable (continued symptoms despite maximum medical therapy). The disease is completely cured when the colon is removed.

Familial Adenomatous Polyposis (FAP) is an inherited condition in which hundreds and even thousands of polyps develop in the colon, again at a young age. By the age of about 20 years, if the colon is not removed, colon cancer will inevitably develop.

Miscellaneous conditions can also lead to removal of most or all of the colon, or can create a non-functioning rectum leading to a colostomy. These include tumors and cancer, injuries to the nerves that control evacuations and continence, and damage to the rectum and anus from trauma. In order to avoid a colostomy or ileostomy bag (external appliance), the continent ileostomy (BCIR) is an option.

Crohn's Disease also can require removal of the entire colon and rectum. In contrast to UC, Crohn's disease can affect not only the large intestine but also the small intestine, sometimes at the same time and sometimes at different times in a person's life. If it only affects the colon, it may in select cases be appropriate to perform a BCIR as an alternative to a conventional ileostomy. If the small intestine is involved, however, it is not safe to do the BCIR because the internal pouch is created out of the small intestine which must be healthy.

Of course, the decision to remove the colon and to create the BCIR in any of these conditions is a very individual issue, requiring careful consideration and discussion between the patient and the expert surgeon who performs this operation.