Unless total colectomy is done as an emergency procedure, efforts should be made to improve the patient's nutritional status with a high-protein, high-calorie diet. Total parenteral nutrition may be used. The blood volume is restored and supplemental vitamins are provided. The surgeon must carefully evaluate the status of the steroid therapy. The patient requires special psychologic preparation for the ileostomy. This should include a visit by an enterostomal therapist who can demonstrate successful rehabilitation following this procedure. The patient should be shown the permanent type of ileostomy appliance and should be encouraged to read the literature available from an ileostomy club to prepare him or her for postoperative management. In addition, the site of the ileostomy should be selected away from bony prominences and previous scars as described in Plate 58. A permanent type of appliance may be glued to the patient's skin for 1 to 2 days to allow him or her to move about with it in place and make any final adjustments in its eventual location. This point is marked with indelible ink to assure accurate placement of the stoma. A liquid diet is given for 1 or 2 days, followed by laxative purging the afternoon and evening prior to surgery. The male patient should be informed of the possibility of postoperative impotence, retrograde ejaculation, and difficulty in voiding.