Ileoanal Reservoir (Pouch)

Linda B. Hurd, RN, MSN

The ileoanal reservoir procedure is a surgical treatment option for chronic ulcerative colitis, colon cancer and familial polyposis patients who need to have their large intestine (colon) removed. An ileoanal reservoir (or pouch) is an internal pouch formed of small intestine. This pouch provides a storage place for stool in the absence of the large intestine. Anal sphincter muscles assist in holding in the stool. Several times a day, stool is passed through the anus.

Ileoanal reservoir surgery is a widely accepted surgical treatment for ulcerative colitis or familial polyposis because it eliminates the disease, gives the patient control of bowel movements and does not require a permanent ileostomy. Each patient considering this surgery is carefully evaluated to determine if this procedure is appropriate for them. This procedure is performed in one, two or three stages, but is most often done in two stages, usually 2-3 months apart.

Stage I:

The first surgery removes the entire large bowel and the lining of the rectum, but leaves the rectal muscle intact. A reservoir or “pouch” is made out of small intestine and then is connected to the anus. Next, a temporary ileostomy is made. An ileostomy is a surgically created opening between the small bowel and the skin of the abdomen through which stool and gas are passed. This temporary ileostomy diverts the stool; protecting the reservoir (pouch)while it heals. (See figures 1, 2 and 3)

What to expect after the first surgery:

In the initial weeks after surgery, waste material coming through the ileostomy is liquid but then begins to thicken. A good diet with increased fluid intake is needed to keep well hydrated and nourished. Patients wear an ileostomy appliance over the ileostomy that collects the waste as it passes through the ostomy (or opening) on the abdomen. Learning to care for the ileostomy is a little tricky but with practice becomes very manageable. Patients also may occasionally pass small amounts of mucus or blood through the rectum.

Approximately four to six weeks after the first surgery, an x-ray study of the pouch is performed. If the study shows that the pouch is healed, then the second surgery can be scheduled.