View source for Ileostomy

{{Short description|Surgical procedure}}
{{More medical citations needed|date=January 2022}}
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{{Infobox interventions
| Name        = Ileostomy
| Image       = Ileostomy 2017-02-20 5349.jpg
| Caption     = Ileostomy
| ICD10       =
| ICD9        = {{ICD9proc|46.2}}
| MeshID      = D007081
| MedlinePlus = 007378
| OtherCodes  =
}}

'''Ileostomy''' is a [[stoma (medicine)|stoma]] (surgical opening) constructed by bringing the end or loop of [[small intestine]] (the [[ileum]]) out onto the surface of the skin, or the surgical procedure which creates this opening.<ref name=":2">{{Cite web |title=Types of ileostomy: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000073.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref>  Intestinal waste passes out of the ileostomy and is collected in an external [[Ostomy pouching system|ostomy system]] which is placed next to the opening.  Ileostomies are usually sited above the [[groin]] on the right hand side of the [[abdomen]].

==Uses==
Ileostomies are necessary where injury or a surgical response to disease has meant the [[large intestine]] cannot safely process waste, typically because the [[colon (anatomy)|colon]] and [[rectum]] have been partially or wholly removed.

Diseases of the large intestine which may require surgical removal include [[Crohn's disease]], [[ulcerative colitis]], [[familial adenomatous polyposis]], and total colonic [[Hirschsprung's disease]].<ref name="Guide">[http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Ileostomy.asp ''Ileostomy Guide''] {{Webarchive|url=https://web.archive.org/web/20070929091245/http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Ileostomy.asp |date=2007-09-29 }}; by the [[American Cancer Society]]; Cancer.org website; retrieved January 2014.</ref>  An ileostomy may also be necessary in the treatment of [[colorectal cancer]] or [[ovarian cancer]].  One example is a situation where the cancer [[tumor]] is causing a blockage (obstruction).<ref>{{cite web |last1=Services |first1=National Health |title=Why it's used - Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/why-its-done/ |website=NHS |access-date=11 September 2020}}</ref>  In such a case, the ileostomy may be temporary, as the common surgical procedure for colorectal cancer is to reconnect the remaining sections of colon or rectum following removal of the tumor provided that enough of the rectum remains intact to preserve [[internal anal sphincter|internal]]/[[external anal sphincter]] function.

In an ''end ileostomy'', the end of the ileum is everted (turned inside out) to create a spout and the edges are sutured under the skin to anchor the ileum in place.  Permanent ileostomies are usually done this way.  An end ileostomy may be temporary, notably if some of the large intestine was removed and the bowel or overall health is not considered amenable to tolerating further surgery, such as an [[anastomosis]] to rejoin the small and large intestines.

=== Duration ===
In a ''temporary'' or ''loop ileostomy'', a loop of the ileum is surgically brought through the skin creating a stoma, but keeping the lower portion of the ileum for future reattachment in cases where the entire colon and rectum are not removed but need time to heal.  Temporary ileostomies are also often made as the first stage in surgical construction of an [[ileo-anal pouch]], so [[Human feces|fecal]] material does not enter the newly made pouch until it heals and has been tested for leaks—usually requiring a period of eight to ten weeks. When healing is complete the temporary ileostomy is then "taken down" (or reversed) by surgically repairing the loop of intestine which made the temporary stoma and closing the skin incision.<ref>{{cite web |last1=Services |first1=National Health |title=Reversal - Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/reversal/ |website=NHS |access-date=11 September 2020}}</ref>

==Living with an ileostomy==
[[File:Ileostomy 2016-09-09 4158.jpg|thumb|Ileostomy with bag (pouch).]]{{See also|Ostomy system}}
People with ileostomies must use an ''[[Ostomy pouching system|ostomy pouch]]'' to collect intestinal waste.  People with ileostomies typically use an open-ended (referred to as a "drainable") one- or two-piece pouch that is secured at the lower end with a leakproof clip, or velcro fastener.  The alternative is the closed-end pouch that must be thrown away when full.  Ordinarily, the pouch must be emptied five to eight times a day.<ref>Note: many ostomates find it convenient to do this whenever they make a trip to the bathroom to [[urinate]]</ref><ref name=":1">{{Cite web |title=Ileostomy - discharge: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000074.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref> If the bag stays empty for more than four to six hours, individuals should contact their healthcare provider, as this may indicate intestinal blockage.<ref name=":1" /> The pouch and flange (both one and two piece pouches) are usually changed every 2–5 days.<ref name=":3">{{Cite web |title=Ileostomy - changing your pouch: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000072.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref>

Ostomy pouches fit close to the body and are usually not visible under regular clothing unless the pouch becomes too full.  It is necessary to measure the stoma regularly as it changes shape after the initial surgery. The stomal- or colorectal-nurse does this initially for a patient and advises them on the exact size required for the pouch's opening. Changes in size and shape can indicate a problem and may signal a need to call a healthcare provider.<ref name=":3" />

Some people find they must make adjustments to their diet after having an ileostomy. It is important for individuals to consult with their healthcare providers.<ref name=":1" />  Tough or high-[[Dietary fiber|fiber]] foods (for example: potato skins, tomato skins, and raw vegetables) are hard to [[digestion|digest]] in the small intestine and may cause blockages or discomfort when passing through the stoma.  Chewing food thoroughly can reduce such problems.<ref name=":1" />  Some people find that certain foods cause annoying gas or [[diarrhea]].<ref name=":4">{{Cite web |title=Ileostomy and your diet: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000070.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref>  Many foods can change the color of the intestinal output, causing alarm; beetroot, for instance, produces a red output that may appear to be blood.<ref name=":4" />  Nevertheless, people who have an ileostomy as treatment for [[inflammatory bowel disease]] typically find they can enjoy a more "normal" diet than they could before surgery.  Correct dietary advice is essential in combination with the patient's gastroenterologist and hospital-approved dietician.  Supplementary foods may be prescribed and liquid intake and output monitored to correct and control output. If the output contains blood, an ileostomate (patient) is advised to visit an emergency department.<ref>{{cite web |publisher=National Health Service |title=Living with an ileostomy -Ileostomy |url=https://www.nhs.uk/conditions/ileostomy/living-with/ |website=NHS |access-date=11 September 2020}}</ref>

After having ileostomies, people may continue to take baths and showers and have an active lifestyle.<ref name=":1" /><ref>{{Cite web |title=Living with your ileostomy: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000075.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref> These and other topics are important to discuss with healthcare providers.<ref>{{Cite web |title=Ileostomy - what to ask your doctor : MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000227.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en}}</ref>

Complications can include [[kidney stones]], [[gallstones]], and [[adhesion (medicine)|post-surgical adhesions]].<ref>{{cite journal |vauthors=Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM |others=Surgical and Clinical Adhesions Research (SCAR) Group |title=The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. |journal= Colorectal Disease |volume=7 |issue=6 |pages=551–558 |quote= A 5-year study [this] of patients who had ileostomy surgery in 1997 found the risk of adhesion-related hospital readmission to be 11%.| year=2005 |pmid=16232234 |doi=10.1111/j.1463-1318.2005.00857.x  |s2cid=12584557 |doi-access= }}
</ref>

==Other options==
In some patients with Crohn's disease, a procedure called an [[ileoanal anastomosis]] is done if the disease affects the entire colon and rectum, but leaves the anus unaffected. In this procedure, the entire large intestine and rectum is surgically removed, and the ileum is then stitched to the anus to allow fecal matter to go through the ileum just as it did when the patient had a large intestine. This procedure requires a temporary loop ileostomy to allow the anastomosis to heal. With lifestyle adjustments, those who have had this procedure for their Crohn's disease can resume normal bowel movements without artificial appliances. However, there is always the possibility of disease relapse, as Crohn's can affect mouth to anus.<ref name=":0">{{Cite web|url=https://www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel|title=Ostomy Surgery of the Bowel {{!}} NIDDK|website=National Institute of Diabetes and Digestive and Kidney Diseases|language=en-US|access-date=2019-10-23}}</ref>

<!-- Anchor from redirected article, [Barnett continent intestinal reservoir]; caution when changing. -->
Since the late 1970s, an increasingly popular alternative to an ileostomy has been the ''Barnett continent intestinal reservoir'' (or BCIR).  The formation of this pouch (made possible through a procedure first pioneered by [[Nils Kock]] in 1969), involves the creation of an internal reservoir which is formed using the [[ileum]] and connecting it through the abdominal wall in a very similar fashion to a standard "Brooke" ileostomy.<ref name="Reservoir">[https://link.springer.com/article/10.1007/BF02048167#page-1 ''Nils G. Kock'']; Classic Article; foreword by Corman, Marvin L., M.D.; March 1994; Springer (web); Volume 37, Issue 3; excerpt from "Diseases of the Colon & Rectum"; Chapter: Intra-abdominal 'Reservoir' in Patients With Permanent Ileostomy; Pp. 278–279.</ref>  The BCIR procedure should not be confused with a [[Ileo-anal pouch|J-pouch]], which is also an ileal reservoir, but is connected directly to the [[Human anus|anus]]—after removal of the [[colon (anatomy)|colon]] and [[rectum]]—avoiding the need for subsequent use of external appliances.<ref name=":0" /> Because continent ileostomies can cause problems and may need redoing, they are not often done.<ref name=":2" /> However, continent ileostomies can be considered depending on surgeon experience, patient characteristics, and other factors.<ref>{{Cite journal |last1=Angistriotis |first1=Athanasios |last2=Shen |first2=Bo |last3=Kiran |first3=Ravi Pokala |date=2022-09-23 |title=Construction of and Conversion to Continent Ileostomy: A Systematic Review |journal=Diseases of the Colon and Rectum |volume=65 |issue=S1 |pages=S26–S36 |doi=10.1097/DCR.0000000000002631 |issn=1530-0358 |pmid=36165572|s2cid=252540995 }}</ref>

=== Barnett continent intestinal reservoir ===

The Barnett continent intestinal reservoir (BCIR) is a type of an appliance-free intestinal [[ostomy]].  The BCIR was a modified [[Kock pouch]] procedure pioneered by William O. Barnett.  It is a surgically created pouch, or reservoir, on the inside of the [[abdomen]], made from the last part of the [[small intestine]] (the [[ileum]]),<ref name="Reference 13" /> and is used for the storage of intestinal [[Human feces|waste]].  The pouch is internal, so the BCIR does not require wearing an appliance or [[Ostomy pouching system|ostomy bag]].

====How it works====
The pouch works by storing the liquid waste, which is drained several times a day using a small silicone tube called a [[catheter]].  The catheter is inserted through the surgically created opening on the abdomen into the pouch called a [[Stoma (medicine)|stoma]].  The capacity of the internal pouch increases steadily after surgery: from 50&nbsp;cm<sup>3</sup>, when first constructed, to 600–1000&nbsp;cm<sup>3</sup> over a period of months, when the pouch fully matures.

The opening through which the catheter is introduced into the pouch is called the [[Stoma (medicine)|stoma]].  It is a small, flat, button-hole opening on the abdomen.  Most patients cover the stoma site with a small pad or bandage to absorb the [[mucus]] that accumulates at the opening.<ref name="Reference 6" /><ref group=Note name=Note02/>  This mucus formation is natural, and makes insertion of the catheter easier.  The BCIR requires no external appliance and it can be drained whenever it is convenient. Most people report draining the pouch 2–4 times a day, and most times they sleep through the night. This can vary depending on what kinds and quantities of food eaten. The process of draining the pouch is simple and quickly mastered. The stoma has no nerve endings, and inserting the catheter is not painful. The process of inserting the catheter and draining the pouch is called ''[[intubation]]'' and takes just a few minutes.

====Background and origin====
Finnish surgeon [[Nils Kock]] developed the first intra-abdominal continent ileostomy in 1969. This was the first continent intestinal reservoir. By the early 1970s, several major medical centers in the United States were performing Kock pouch ileostomies on patients with ulcerative colitis and familial polyposis.  One problem with these early Kock pouches was valve slippage,<ref name="Reference 5" /> which often resulted in difficulty [[Intubation|intubating]] and an [[Fecal incontinence|incontinent pouch]]. As a result, many of these pouches had to be revised or removed to allow a better [[quality of life]].

William O. Barnett began modifying the Kock pouch in 1979. He believed in the concept of the continent reservoir, but was disappointed with the valve's relatively high failure rate. Barnett was intent on solving the problem.<ref name="Reference 5" /><ref group=Note name=Note03/> His first change was in the construction of the nipple valve. He changed the direction of flow within this segment of intestine to keep the valve in place. This greatly improved the success rate.<ref name="Reference 6" /><ref group=Note name=Note01/> In addition, he used a plastic material called [[Marlex]] to form a collar around the valve.<ref name="Reference 5" /> This further stabilized and supported the valve, decreasing valve slippage. This technique worked well, but after several years, the intestine reacted to the Marlex by forming ''[[fistula]]e'' (abnormal connections) into the valve.  Dr. Barnett continued his investigation in an effort to improve these results.  After much effort, the idea came to him—a "living collar" constructed from the small intestine itself.  This technique made the valve more stable and eliminated the problems the Marlex collars had presented.<ref name="Reference 5" />

After a test series of over 300 patients, Barnett moved to [[St. Petersburg, Florida]] where he joined the staff of [[Palms of Pasadena Hospital]], where he trained other surgeons to perform his continent intestinal reservoir procedure.  With the assistance of James Pollack, the first BCIR Program was established.  Both surgeons further enhanced the procedure to bring it to where it is today.  These modifications included reconfiguring the pouch to decrease the number of [[Surgical suture|suture lines]] from three to one (this allowed the pouch to heal faster and reduced the chance of developing fistulae); and creating a ''[[serosal]]'' patch over the suture lines which prevented leakage.<ref name="Reference 6" /><ref group=Note name=Note04/>  The end result of these developments has been a continent intestinal reservoir with minimal complications and satisfactory function.<ref name="Reference 7" />

====Surgical candidates====
Ulcerative colitis<ref name="Reference 11" /> and familial adenomatous polyposis<ref name="Reference 10" /> are the two main health conditions that lead to removal of the entire [[Colon (anatomy)|colon]] (large intestine) and [[rectum]], which leads to the need for an ileostomy.<ref name="Reference 8" /><ref name="Reference 12" /><ref group=Note name=Note05/>

Candidates for BCIR include: people who are dissatisfied with the results of an alternate procedure (whether a conventional Brooke ileostomy or another procedure); patients with a malfunctioning/failed Kock pouch or [[Ileo-anal pouch|IPAA/J-pouch]]; and individuals with poor [[internal anal sphincter|internal]]/[[external anal sphincter]] control who either elect not to have the J-pouch (IPAA) or are not a good candidate for IPAA.<ref name="Reference 1" />

There are, however, some contraindications for having the BCIR surgery. BCIR is not for people who have or need a [[colostomy]], people with [active] [[Crohn's disease]], mesenteric [[desmoid]]s, [[obesity]], advanced age, or poor motivation.<ref name="Reference 2" />

When Crohn's disease 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 affected, however, it is not safe to have the BCIR (because the internal pouch is created out of the small intestine, which must be healthy).

A patient must have an adequate length of [[small intestine]] to be considered a potential candidate.

====Success rates and case studies====
;ASCRS study, 1995
A 1995 study by the [[American Society of Colon and Rectal Surgeons]] included 510 patients who received the BCIR procedure between January 1988 and December 1991.  All patients were between 1–5 years post-op with an admitting diagnosis of ulcerative colitis or familial polyposis.  The study was published in ''Diseases of the Colon and Rectum'' in June 1995.<ref name="Reference 1" />   The study found that:
:* Approximately 92% of the patients have functional BCIR pouches at least one year after surgery;
:* 87.2% of patients required no or minor subsequent surgery to ensure a functioning pouch;
:* 6.5% of patients required subsequent excision (removal) of the pouch (with the majority of these having occurred within the first year (63.6%);
:* Re-operation rate for major pouch-related complications (other than pouch removal) was 12.8% (including: slipped valve (6.3%), valve [[fistula]]s (4.5%), and pouch fistulas (6.3%));
::* Of the 32 patients treated for valve slippage, 23 achieved a fully functioning pouch.  Pouch or valve fistulas affected 52 patients, 39 ultimately achieved successful results.  Pouch leaks occurred in 11 patients, of these 7 have functioning pouches.
:* Complications not related to the pouch itself parallel those that accompany other abdominal surgeries; with the most frequent being small [[bowel obstruction]] (which occurred in 50 patients, 20 of whom required surgical intervention);
:* "Several questions were administered to patients whose responses revealed a significant improvement in general [[quality of life]], state of mind, and overall health;<ref name="Reference 1" /> Over 87% of the patients in this study feel their quality of life is better after having the BCIR.

The study concluded: "BCIR represents a successful alternative to patients with a conventional Brooke ileostomy or those who are not candidates for the [[Ileo-anal pouch|IPAA]]."<ref name="Reference 1" />

;ASCRS special study, 1999
In 1999, American Society of Colon and Rectal Surgeons published a unique study on 42 patients with a failed [[Ileo-anal pouch|IPAA/J-pouch]] who converted to the Barnett modification of the Kock pouch (BCIR).  The authors noted that their study was significant in the very large number of patients,<ref name="Reference 3" /> approximately 6 times more than studied by any previous author.<ref name="Reference 4" />  The study was published in ''Diseases of the Colon and Rectum'' in April 1999.<ref name="Reference 4" />  The study found:
:* that forty (95.2%) patients of the failed [[Ileo-anal pouch|IPAA]] population reported fully functioning pouches;
:* that two pouches had been excised, one after development of a pouch vesical fistula, the other after emergence of [[Crohn's disease]], which had not been diagnosed at the time of the original [[colectomy]];
:* that "Forty (100%) of the patients with failed IPAAs who retained their pouch rated their life after the continent ileostomy as better or much better than before."<ref name="Reference 4" />

The study concluded: "The continent ileostomy offers an alternative with a high degree of patient satisfaction, to those patients who face the loss of an [[Ileo-anal pouch|IPAA]]."<ref name="Reference 4" />

==Notes==
{{reflist|2|group=Note|refs=
<ref name=Note01>The intestinal collar communicates with the pouch in such a way that buttresses the nipple valve and conduit, providing increased security against leakage.</ref>
<ref name=Note02>Patients may place a simple dressing over the flush stoma.</ref>
<ref name=Note03>Barnett states that over a period of nine years (and 315 patients) they strove to decrease malfunctioning pouches and the need for additional operations.</ref>
<ref name=Note04>Leakage through one of the reservoir suture lines used to be a much more common complication than it is today, thanks to improved construction of the reservoir and careful selection of patients.</ref>
<ref name=Note05>There is no cure for ulcerative colitis, but surgery may be recommended in chronic cases where medical therapy fails. Surgical options include a proctocolectomy, or creating a Brooke ileostomy or continent ileostomy.</ref>
}}

==References==
{{reflist|2|refs=
<ref name="Reference 1">{{cite journal | author = Mullen Patrick, Behrens Donald, Chalmers Thomas, Berkey Catherine, Paris Martin, Wynn Michael, Fabito Daniel, Gaskin Ronald, Hughes Tyler, Schiller Don, Veninga Francis, Vilar Pio, Pollack James | year = 1995 | title = Barnett continent intestinal reservoir: Multicenter experience with an alternative to the Brook ileostomy | url = | journal = Diseases of the Colon & Rectum | volume = 38 | issue = 6| pages = 573–582 | doi = 10.1007/BF02054114> }}</ref>
<ref name="Reference 2">{{cite journal | author = Vernava III A. M., Goldberg S. M. | year = 1988 | title = Is the Kock pouch still a viable option? | url = | journal = International Journal of Colorectal Disease | volume = 3 | issue = 2| pages = 135–138 | doi = 10.1007/BF01645320 }}</ref>
<ref name="Reference 3">Behrens, Donald T.; Paris, Martin; Luttrell, Josiah. (May 1999), "The Authors Reply", Diseases of the Colon & Rectum (American Society of Colon and Rectal Surgeons) 42(5)</ref>
<ref name="Reference 4">{{cite journal | author = Behrens Donald T., Paris Martin, Luttrell Josiah | year = 1999 | title = Conversion of failed ileal pouch-anal anastomosis to continent ileostomy | url = | journal = Diseases of the Colon & Rectum | volume = 42 | issue = 4| pages = 490–6 | doi = 10.1007/BF02234174 }}</ref>
<ref name="Reference 5">{{cite journal | pmid = 2535766 | volume=168 | issue=1 | title=Current experiences with the continent intestinal reservoir | year=1989 | author=Barnett WO | journal=Surg Gynecol Obstet | pages=1–5 }}</ref>
<ref name="Reference 6">{{cite book|last=Corman|first=Marvin|title=Colon and Rectal Surgery|year=1993|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0397511785|pages=966–973}}</ref>
<ref name="Reference 7">{{cite journal | author = Lian L, Fazio VW, Remzi FH, Shen B, Dietz D, Kiran RP | year = 2009 | title = Outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis | url = | journal = Diseases of the Colon & Rectum | volume = 52 | issue = 8| pages = 1409–14 | doi = 10.1007/DCR.0b013e3181ab586b }}</ref>
<ref name="Reference 8">{{cite journal | author = McLeod RS | year = 2003 | title = Surgery for inflammatory bowel diseases | url = | journal = Dig. Dis. | volume = 21 | issue = 2| pages = 168–79 | doi = 10.3748/wjg.14.2678 | doi-access=free}}</ref>
<!-- This reference not used in the text<ref name="Reference 9">{{cite journal | author = Nessar G, Fazio VW, Tekkis P, Connor J, Wu J, Bast J | display-authors = etal | year = 2006 | title = Long-term outcome and quality of life after continent ileostomy | url = | journal = Diseases of the Colon and Rectum | volume = 49 | issue = 3| pages = 336–44 }}</ref>  -->
<ref name="Reference 10">{{cite web|last=Dietz|first=David|title=Familial Adenomatous Polyposis (FAP)|url=http://www.fascrs.org/physicians/education/core_subjects/2006/fap/|publisher=ASCRS|access-date=16 December 2012|archive-url=https://web.archive.org/web/20131206045159/http://www.fascrs.org/physicians/education/core_subjects/2006/fap/|archive-date=6 December 2013|url-status=dead}}</ref>
<ref name="Reference 11">{{cite web|title=Ulcerative Colitis|url=http://www.fascrs.org/patients/conditions/ulcerative_colitis/|publisher=ASCRS|access-date=16 December 2012|archive-url=https://web.archive.org/web/20130102054007/http://www.fascrs.org/patients/conditions/ulcerative_colitis/|archive-date=2 January 2013|url-status=dead}}</ref>
<ref name="Reference 12">{{cite web|title=Colorectal Diseases and Treatments|url=http://www.fascrs.org/aboutus/press_room/backgrounders_and_tip_sheets/colorectal/|publisher=ASCRS|access-date=16 December 2012|archive-url=https://web.archive.org/web/20121121041637/http://www.fascrs.org/aboutus/press_room/backgrounders_and_tip_sheets/colorectal/|archive-date=21 November 2012|url-status=dead}}</ref>
<ref name="Reference 13">{{cite web|title=Ostomy|url=http://www.fascrs.org/patients/treatments_and_screenings/ostomy/|publisher=ASCRS|access-date=16 December 2012|archive-url=https://web.archive.org/web/20130103025004/http://www.fascrs.org/patients/treatments_and_screenings/ostomy/|archive-date=3 January 2013|url-status=dead}}</ref>
}}

==External links==
* [http://ileostomy-surgery.com ''Ileostomy-surgery''] {{Webarchive|url=https://web.archive.org/web/20131231204816/http://ileostomy-surgery.com/ |date=2013-12-31 }} website
* [http://www.fascrs.org/ ''American Society of Colon & Rectal Surgeons'']; ASCRS website
* ''[http://www.ostomy.org/ United Ostomy Associations of America]''; Ostomy Association website (visited: May 23, 2018)

{{Stomas}}
{{Digestive system surgical procedures}}
{{Authority control}}

{{DEFAULTSORT:Ileostomy}}
[[Category:Digestive system surgery]]
[[Category:Abdominal surgical procedures]]