Ileoscopy

Endoscopic examination of an ileostomy is indicated in patients with changes in bowel function, with bleeding, in patients with familial adenomatous polyposis who may have ileal polyps, or in those with Crohn’s disease who may have a recurrence. It can be done with a rigid or flexible scope. Because of the small caliber of the bowel, pediatric scopes are necessary. A rigid pediatric proctoscope will fit almost all ileostomies and can provide good information about the status of the distal 15cm of the bowel. The scope is generously lubricated and placed vertically over the stoma. The weight of the scope itself is allowed to carry the instrument into the stoma. The obturator can then be removed and the insufflator used to demonstrate the lumen and facilitate further advance. Once through the abdominal wall, the scope may need to be angled to follow the bowel. Suction is important as stool is usually present and there has been no prep.

Flexible Ileoscopy is generally easier than rigid and can be more comfortable for the patient, depending on how far the examiner pushes the scope. I have used a pediatric gastroscope (that was called an” ileoscope”) for this purpose. As the tip of the scope is inserted into the stoma, gas and water are insufflated to allow the lumen to be followed. The path of the bowel through the abdominal wall should be straight, but the intra-abdominal ileum is usually quite tortuous and there may be adhesions or a hernia that distort the bowel. Significant mucosal lesions include ulcers which may be from Crohn’s disease, polyps, or stenoses. A dilated segment of ileum above a stenosis implies that the stenosis is significant and likely symptomatic. Stenoses can be dilated although sedation is usually needed.