End ileostomy is when a surgeon removes the colon and creates a stoma in the abdomen for the end of the small intestine and waste to pass through.

A person may need an end ileostomy if their large intestine (colon) can no longer function properly or if using the colon makes them very ill.

The idea of an end ileostomy can be overwhelming, but many people find it resolves long-standing problems and ultimately improves their quality of life.

Ileostomies and other ostomies are relatively common. In the United States, up to 1 million people live with an ostomy, and around 100,000 ostomy procedures are done each year, according to a 2022 research paper.

In this article, find out what to expect with an end ileostomy and some of its risks and complications.

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An end ileostomy is when a surgeon makes an incision in the abdomen and removes the colon, leaving the end of the ileum, or small intestine, protruding from the skin.

After the surgery, a person wears a pouch to collect waste and empties the pouch as necessary. They no longer use the anus to remove waste.

A loop ileostomy is an ileostomy that bypasses part of the digestive tract. A surgeon may rejoin the ends at a later date.

With an end ileostomy, the digestive tract ends at the stoma, or opening in the skin. The person uses this system permanently.

A doctor may recommend an end ileostomy for people with the following conditions:

An end ileostomy is a major surgery. It is done in a hospital under general anesthesia. A person may have open or laparoscopic surgery.

End ileostomy generally follows these steps:

  1. A surgeon makes a small cut, usually on the right-hand side of the abdomen, for the small intestine to pass through.
  2. The surgeon separates the small intestine from the large intestine.
  3. The surgeon pulls the end of the small intestine through the skin and stitches it to the skin around the opening.

A surgeon may need to make a larger cut down the abdomen to remove the large intestine.

Learn more about how to prepare and what to expect with an ileostomy.

Various risks and complications can arise after surgery and in the long term.

After surgery, there may be a risk of:

  • infection around the wound
  • bleeding from the stoma
  • retraction, when the intestine disappears inside the stoma
  • dehydration due to fluid loss
  • excess waste leaving the stoma
  • too little waste, which may indicate a blockage
  • discomfort, pain, and swelling around the stoma
  • nausea
  • separation of the stoma from the surrounding skin
  • mental health challenges around having a stoma

A blockage can be serious. A person may notice cramps and pain, which can be severe. A blockage may lead to a rupture without treatment.

Around 1% to 5% of people experience necrosis, or death of tissue, at the stoma due to low blood supply. However, the risk is low because the ileum has a dense network of blood vessels. Necrosis usually happens within 24 hours, when most people are still under a surgeon’s care.

A person should speak with a healthcare professional if they have concerns about the stoma within the first 30 days after the procedure.

A mental health professional can help manage any anxiety and other mental health challenges.

Learn about colostomy bags and how to use them.

Long-term complications

A healthcare professional will provide training in caring for a stoma, what to expect, and how to reduce the risk of complications.

Here are some complications that may arise in the long term, although they may also occur soon after surgery:

ComplicationWhat is it?Signs and symptoms
peristomal dermatitisskin inflammation around the stoma• irritation
• redness
• soreness
stoma retractionthe stoma is below the skin levelincreases the risk of:
• swelling
• abscess
• bleeding
• tissue death
• skin infection
small bowel obstructionblockage above the stoma• cramps
• pain
• bloating
• low waste output
high outputtoo much waste leaves the stoma; output usually ranges from 600 to 1,200 milliliters per day• dehydration
• electrolyte imbalance
• weight loss
• low blood pressure
stoma prolapsestoma protrudes inwardlystoma disappears from view
stoma herniapart of the bowel pushes against the skin, causing a bump or protrusion• pain
• discomfort
• swelling
• difficulty fitting pouch appliances, leading to leakage
stricture of the stomathe stoma narrowswaste cannot pass out of the stoma
nutritional deficienciesthe body cannot absorb certain nutrients if some of the small intestine is removedsymptoms of vitamin B deficiency, among others

Learn more about what the expected output of waste is for an ileostomy.

After surgery, a person can expect to need:

  • 6 to 8 weeks to recover and return to their usual activities
  • at least 6 weeks before they can drive
  • 3 months before doing any heavy lifting to allow the abdominal muscles to heal
  • plenty of rest to recover from surgery and get used to the changes
  • a low fiber diet for the first 6 weeks, which a healthcare professional can advise on
  • advice and training in using the new equipment

Having an end ileostomy does not need to affect a person’s ability to live a full and active life, to wear their usual clothes, to work, and so on. However, it can take time to adjust.

Specialist healthcare professionals can guide a person if they have concerns about the practical implications or other aspects of life, such as self-image, relationships, and sex.

Learn more about what to eat after an ileostomy.

After an end ileostomy, a person may need to visit a doctor if they experience:

  • pain or discomfort
  • bleeding
  • change in the shape or appearance of the stoma and the area around it
  • change in waste output
  • signs of infection, such as a fever or inflammation of the skin around the stoma
  • cramps and low waste output, which could indicate a blockage
  • concerns about using the equipment
  • anxiety or other mental health challenges stemming from having an end ileostomy
  • any other concerns

Learn more about what the waste consistency should be with an ileostomy.

Here are some questions people often ask about an end ileostomy.

What causes an end ileostomy?

A person may need an end ileostomy if they have a digestive condition, such as colorectal cancer, Crohn’s disease, ulcerative colitis, or familial adenomatous polyposis. It can help people whose colon can no longer function or when waste passing through the colon could result in serious symptoms or disease.

Can an end ileostomy be reversed?

A loop ileostomy can be reversed, but an end ileostomy cannot be reversed. In an end ileostomy, the digestive tract is removed and there is nothing to attach it to later. The stoma will remain for the rest of the person’s life.

What is permanent end ileostomy?

A permanent end ileostomy is the same as an end ileostomy.

What is an end stoma?

An end stoma is when a surgeon makes a hole in the body at the end of a part of the digestive tract to enable waste to exit. It may bypass a blockage or prevent problems from occurring lower in the digestive tract. It may be an ileostomy or a colostomy.

An end ileostomy is a procedure in which a surgeon removes the colon so that the small intestine ends at an opening in the skin of the abdomen. It allows waste to leave the body without passing through the colon.

An end ileostomy can help people with IBD and other serious conditions that affect the large intestine.

Adjusting to using a stoma can take time, but many people find it eliminates previous symptoms and increases their quality of life and well-being.