Ileostomy Creation & Takedown

Procedure Snapshot

• Indication: Diversion for distal anastomosis protection or bowel rest.
• Expected duration: ___
• Special instruments: Stoma marking set, circular stapler, rods.

Step Workflow

Creation

1. Identify terminal ileum 20–30 cm from cecum.
2. Deliver through RLQ site within rectus.
3. Mature Brooke end or loop stoma.

Takedown

1. Excise mucocutaneous junction.
2. Mobilize bowel; re-enter peritoneum.
3. Perform stapled side-to-side or end-to-end anastomosis.
4. Close fascia.

Key Pimp Questions

• Q: Complications?
  A: Dehydration, prolapse, retraction (PMID 30711242).
• Q: Timing of reversal?
  A: 6–12 weeks when healed.

Critical Anatomy

• Landmarks: Terminal ileum, mesentery, rectus sheath.
• Danger zones: Epigastric vessels, ureter.

Informed Consent Highlights

• Risks: Leak __, wound infection __, obstruction ___.

Post-op Considerations

• Hydration; monitor output >1 L/day → treat with loperamide.

References

• Chassin’s, Stoma section.
• Clinical Scenarios, Small Bowel.
• Chen 2019 (PMID 30711242).