Common Conditions Leading To Ileostomy Surgery

Ulcerative Colitis and Familial Adenomatous Polyposis are the two main health conditions that lead to removal of the entire colon (large bowel) and rectum leading to an ileostomy.

Ulcerative Colitis (UC) is an inflammatory condition that affects the large intestine (never the small intestine). The disease is cured when the colon is removed. UC primarily affects young people (teens and early 20s) and after 10 years the incidence of cancer increases. Symptoms include but not limited to frequent urgent bowel movements (10-20 per day) with bleeding. There are medications available with various responses. Surgery is required when the disease is no longer responding to maximum medical therapy or with hemorrhage or perforation.

Familial Adenomatous Polyposis (FAP) or Familial Polyposis (FP) is an inherited condition in which hundreds and even thousands of mushroom-like growths (polyps) blanket the colon. These polyps will eventually become cancerous so the only treatment for FAP is surgical removal of the colon. Since the goal is to prevent cancer, waiting until a polyp becomes malignant is unsafe, as the cancer may invade surrounding tissues.

Crohn's Disease also can require removal of the entire colon and rectum but usually conserving the bowel and performing resections is the standard of initial care. 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.

There are some miscellaneous conditions/diagnosis that can lead to the removal of the entire colon. These can include trauma, tumors and some cancers.

In all cases, the decision to remove the colon and create the BCIR will be considered on an individual basis.