after step 1 , when the ileum is diverted, one end goes to the stoma and the other end goes down to the pouch. is it closed off completely so nothing can go down to the pouch and evrything goes right out the stoma? can strictures and things happen before the takedown?

1. "is it closed off completely so nothing can go down to the pouch and evrything goes right out the stoma?"

Yes and maybe. Yes, it is closed off, but some people find the diversion is not perfect and the do indeed have stool that comes out their bottoms too. Mine was closed off well enough that nothing came out my bottom but the occasional mucous (which is normal and to be expected, by the way).

2. "can strictures and things happen before the takedown?"

Yes - they can form before takedown. Hopefully they would be noticed on the "pouchogram" you will receive prior to takedown.

what causes strictures and are they common?

Actually, the end of the ileum leading to the pouch is not closed off. You can consider the diverting ileostomy a "double-barreled" ostomy. The stool should all come out and enter your appliance. However, it will go the way of least resistance and if your appliance is too full or for whatever other reason that the stool finds its way to the "downstream" side of the ostomy, it will make its way down to the pouch. This is not harmful or any cause of concern.

There are several places strictures can occur. The most common place is at the pouch junction with the anus (ileoanal anastomosis), which can be felt on a digital exam. The second most common place is at the top of the pouch. The third is near the ileostomy. These strictures can occur at any time. Strictures are just scar tissue. When they occur at an area where the intestines were cut and joined, it is one of the more common complications. But, they are still not expected. If they occur in the intestines in areas where you did not have surgery, suspect Crohn's.

Jan