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Colostomies are performed for numerous reasons, including obstructive lesions caused by cancer, severe diverticulitis, severe intractable constipation, and trauma. Ileostomies are performed for the same reasons, but permanent ileostomy is reserved almost exclusively for patients with ulcerative colitis and diffuse polyposis of the colon. Although ileal pouch anal anastomosis (IPAA) is now the preferred procedure (see Chapter 93 ), some patients may not be surgical candidates for IPAA or may not be able to tolerate the pouch and must be converted to an ileostomy. Both ileostomies and colostomies may be permanent or temporary, depending on the clinical indication.
Because it involves the removal of the colon, ileostomy often results in more complications than colostomy. Colostomy excreta usually have a free or an intermittent flow that may be facilitated by simple irrigation. Ileostomy effluent has a free flow that should range from 800 to 1000 mL/day, depending on the diet. Ileostomy effluent may be dramatically increased in patients with gastroenteritis. Complications of ileostomies include malfunctioning, prestomal ileitis, irritation of the peristomal skin, and obstruction.
The carefully placed ileostomy is usually situated in the right lower quadrant. Most patients become well versed in taking care of the site. Fig. 92.1 demonstrates the method of placing an appliance over the fistula. Most patients become comfortable with it and empty the appliance several times daily.
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