Hi Ranch,
Ok, let's talk. You said, “Normally the small intestine is attached to the large intestine and there aren't any issues as to blockages there.” Yes, in a normal person with no small or large bowel issues… there are no issues related to blockage. But when you cut the colon off from the small intestine and route the small bowel up and through your abdominal wall, a lot has changed. First, we're assuming none of the small bowel is diseased in any way and is functioning normally. If it's not, then all bets are off. When the small bowel is re-routed through your body, it's no longer in the place nature intended, and there's not a lot of free empty real estate inside your body. That means the new way your bowel is routed could have sharper bends as well as potential kinks in the bowel. You also have to consider that when you start messing with things in the abdominal cavity, the body doesn't like it. So adhesions will form that “grip” the small bowel wherever it rubs against or touches another organ or wall of the cavity, and these adhesions prevent it from moving as it normally does. Think of a snake eating a mouse. That big lump moving through the snake is like food moving through your bowel. If the walls of the bowel (or snake) can't expand because the bowel is stuck to something in a bunch of places, what's in it is going to have a hard time getting through. If the patient has any active disease, i.e., diverticulitis, IBD, Crohn's, any inflammation or stricturing, etc., that's also another reason things won't be normal. Also, consider that many ileostomates have had part of their small bowel removed as well. Rarely does disease activity stop exactly where the small bowel meets the colon… usually both are involved to some extent. Now, normally when you eat, your stomach does a bunch of breaking down the food and your small bowel does the rest. If you don't have all your small bowel, then the food won't be as broken down as it should be when it hits your stoma… hence the “chew, chew, chew” thing. The same goes if there's any disease activity in any of the remaining small bowel, as that will decrease the amount of food that is broken down for digestion.
Blockages don't normally occur at the stoma, as you stated. They typically occur upstream where the problem is, unless the surgeon who made your stoma didn't make the hole in your abdominal wall big enough… but that's pretty rare. So in a perfect world, if you just cut the colon off and routed a healthy small bowel through a hole in your abdomen, and there were no sharp bends or kinks, no adhesions forming, and the skin surrounding your stoma didn't reject the stoma and do something stupid… there shouldn't be any problem with blockages, and you could eat anything you wanted. Of course, what normally wouldn't be digested still won't… but there wouldn't be any restriction on eating.
So let's recap. The reason ileostomates have blockages (obstructions) is primarily because:
They eat foods high in insoluble fiber, like nuts, fruit, corn (popcorn), raw vegetables, etc., that either only get partially digested… or not at all. That fiber can clump together and not be able to pass through a tight bend or any part of the bowel that is adhered to something in your body.
There's inflammation of the bowel.
There's scar tissue. Could be from previous surgeries or where diseased bowel healed.
Adhesions form or the bowel narrows for any reason. This is typical in things like Crohn's disease or UC.
The bowel twists because of the way it's routed, or has to make a sharp turn… or worse, kinks.
So I hope that explains it. As for your last question… surgeons can't reproduce the same transition because it doesn't occur in the same place. And to get to the new place, the bowel has to be routed in a way it wasn't naturally routed. And when you screw with Mother Nature… you ultimately lose.
Let me know if that explains things for ya, and if not, we'll dig deeper. And welcome aboard, ileostomate!
;O)
