There are four different types of loop ileostomies, the standard loop ileostomy, double barrel ileostomy, loop colostomy, and Hartmann's pouch. There are two other types of ileostomies, the continent ileostomy and the ileo-anal reservoir. A loop ileostomy can be temporary or permanent, while the other two types of ileostomies are always permanent.
Ileostomies are performed when a patient has digestive issues such as Crohn's disease, ulcerative colitis, familial polyposis, or cancer. During the surgery, the rectum and colon are removed or bypassed. Waste products drain from the body through a stoma, a surgically created port created when the end of the lowest portion of the small intestines, or ileum, is brought through the abdominal wall. The method of clearing this waste depends on the type of ileostomy performed.
The most common form of loop ileostomy is the standard, or Brooke, ileostomy. The end of the ileum is pulled through the abdominal wall to create the stoma. The stoma is typically placed on the lower right side of the abdomen. The patient has no control over waste output and must wear a collection pouch at all times. The waste contains digestive enzymes which can irritate skin, so it is important for the patient to protect the area around the stoma.
The double barrel ileostomy is meant as a temporary measure. The surgeon creates two stomas, one to remove waste products, and the other to drain mucus material. The second stoma does not require a collection pouch, only a gauze covering.
A loop colostomy is used in situations where there is an immediate requirement for the diversion of waste products, such as in the case of a bowel obstruction. A loop of colon near the obstruction is brought up to the skin to create a stoma. The stoma can be created from any point in the large intestines, rather than the lowest point of the small intestines, like other forms of ileostomies. The loop colostomy does require a pouching system.
The Hartmann's pouch is a procedure where the intestine is pulled through the abdominal wall to create a stoma, like in a standard loop ileostomy. Rather than removing the section of small intestines leading into the large intestines, it is clamped or stitched closed and placed back into the body. This is typically for individuals who do not require an ileostomy as a permanent solution.
Continent ileostomies and ileo-anal reservoir ileostomies are permanent solutions, and are not considered loop ileostomies. Neither require pouches. A patient with a continent ileostomy empties an internal pouch several times each day with a catheter. A patient with an ileo-anal reservoir has natural bowel movements because the pouch is attached, internally, to the rectum. To prevent leakage, the patient's sphincter muscle cannot be damaged.
