Ileostomy Reversal Options: J-Pouch vs. Ileocolic Anastomosis Concerns

Dec 12, 2023 1:51 am

Hi everyone,


I am three months out from two emergency surgeries for ischemic bowel. I had ascending and transverse colon removed. A week later, 18 inches of small intestine were removed and an ileostomy was formed. I have a high output ileostomy partially due to the small intestine missing. My question is about the reversal. One surgeon suggested a J-pouch. Another is recommending ileocolic anastomosis as I still have the descending colon and rectum. I am very nervous about the output afterwards and whether or not I will be living with constant diarrhea or if my descending colon will prevent that. Does anyone know?

Mysterious Mose
Dec 12, 2023 5:44 pm

I wish I could help you. I have an ileostomy, but my entire colon was removed and my small bowel is intact. I considered a reversal. However, after talking to my surgeon, doing some research, and talking to people here, I decided against it. Mostly because of the surety of always having to know the location of a toilet and having to use that toilet a good 10-12 times a day. And then there is the high probability of nighttime accidents to consider. All this helped me to decide that living with the bag is the lesser of two unfortunate situations.

I know this does not really help you much, as my situation is quite different from yours. The function of your missing parts is mostly to remove the water from the stool. In a "normal" person, the descending colon is supposed to solidify the stool as it moves through. Not sure how well this would work in your situation. But given your well-written post, I am probably telling you what you already know. Hopefully, someone with better knowledge can properly answer your question. I just want to say, welcome to the forum. There are many, many people here and someone is bound to have a similar situation. Personally, I still have a lot of things I want to do and places I want to see. I think that travel with the bag is much more doable than without. :-)


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Dec 16, 2023 4:56 am

You have had 2/3rds of your large intestine removed so far.

That is amazing. The fix sounds worse than the solution.

I would really question the high output from a shortened small colon and whether or not the J-pouch or whatever pouch is out there could handle such volume?

J-pouches fail over time or from infection. Can you imagine if it burst?

I don't like the odds. I'm sorry. The odds don't seem in your favor.

At least with an external pouch, you can keep an eye on the volume.

I am not familiar with your second option.

Whatever you decide, stay here to get some answers. Don't decide without knowing some consequences they aren't explaining or "don't know."

Fricking knife-happy quacks.

We know. Stick around.