Ileostomy

Abstract

The first ileostomies were described in the late 1800s. They initially were used to relieve an obstruction from cancer (1,2). As the use of ileostomies evolved, the ileum was simply brought through a defect made in the abdominal wall. Without any type of maturation, such stomas at approximately one week postoperatively developed a type of pseudo-obstruction at the level of the stoma with a high loss of watery fluid, abdominal cramping, and stoma swelling. “Ileostomy dysfunction” (3) was the term coined to describe this phenomena and the etiology was from serositis. In 1941, Dragstedt applied a skin graft to the exposed serosa to prevent this problem (4). In the 1950s, Crile and Turnbull further refined the maturation process by describing an eversion technique where the seromuscular coat was removed from the distal ileum and the mucosa was everted as a sliding graft (5). The current practice of everting the bowel and suturing it to the dermis was described by Brooke in 1952 (6). Even though this procedure is over 40 years old it is still the most common method employed to construct an ileostomy. Four or five centimeters of terminal ileum are exteriorized beyond the skin such that with eversion and suturing of the bowel edge to the dermis a two or three centimeter ileostomy protrudes.