Obstructive and secretory complications of diverting ileostomy

Abstract

This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.

Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire?

“…3,8 However, any stoma may give rise to stoma-related complications, and adversely affects the quality of life and furthermore demands further surgery for its closure, with its own cost, morbidity and mortality. [9][10][11][12][13] Our own experience is of significant morbidity (and even mortality) with DI and its closure. Furthermore, almost 30% of patients did not return for the second procedure, which itself was full of hazard.…”

“…3,8 However, any stoma may give rise to stoma-related complications, and adversely affects the quality of life and furthermore demands further surgery for its closure, with its own cost, morbidity and mortality. 9–13…”

Stoma Complications

“…Risk factors include older age, frailty, proximal stoma location or decreased intestinal length, postoperative ileus or intestinal obstruction, and Crohn's disease. 20 Although patients with colostomies are generally at lower risk of high output and dehydration due to the water absorptive capacity of the colon, many of the physiologic alterations associated with high-output ileostomies can also occur with colostomies, especially among at-risk individuals.…”

Ileostomy: Early and Late Complications

“…End ileostomies can be created when temporary ileostomies fail to protect a recently-formed anastomosis, when the length of the small bowel is insufficient for the performance an ileal pouch-anal anastomosis, or when the perianal area is highly compromised. [2][3][4] Despite being considered a simple procedure, it is often followed by a full panoply of complications. 5 According to the literature, the incidence of stoma-related complications ranges from 21% to 70%.…”

“…End ileostomies can be created when temporary ileostomies fail to protect a recently-formed anastomosis, when the length of the small bowel is insufficient for the performance an ileal pouch-anal anastomosis, or when the perianal area is highly compromised. 2 3 4…”