Inflammatory Bowel Disease: Surgical Management

Question 1

Terminal ileum is pulled through the abdominal wall and forms a stoma or ostomy

Answer 1

Total Proctocolectomy with Permanent Ileostomy

Question 2

Alternative to traditional ileostomy with external pouch

Answer 2

Total Proctocolectomy with Continent Ileostomy

Question 3

Creation of an internal reservoir called a “Kock’s Ileostomy” or “Ileal reservoir” to be drained periodically

Answer 3

Total Proctocolectomy with Continent Ileostomy

Question 4

Removal of the colon and rectum with anastomosis of the ileum and the anal canal

Answer 4

Total Colectomy with Ileoanal Anastomosis

Question 5

Post-op care: Total Proctocolectomy with Continent Ileostomy

Answer 5

1. Monitor character and quality of effluent
2. Teach the client to drain stoma when sensation of fullness is felt
3. Apply a small dressing to keep stoma moist

Question 6

Pre-op care: Total Proctocolectomy with Permanent Ileostomy

Answer 6

1. Administer oral or parenteral antibiotics (Neomycin sulfate (Mycifradin)) as a bowel antiseptic
2. Administer laxative or enema

Question 7

Post-op care: Total Proctocolectomy with Permanent Ileostomy

Answer 7

1. Monitor color, odor, consistency of ileostomy output (effluent)
2. Instruct client to report any foul or unpleasant odor (indicates intestinal blockage or infection)
3. Instruct the client to wear pouch system at all times
4. Apply skin barrier to prevent irritation and injury to the skin