Protocol for the detection and nutritional management of high-output stomas

Abstract

IntroductionAn issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management.Materials and methodsThis study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery.ResultsEarly HOS was observed in 7 (16 %) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16 %) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100 % effectiveness. 50 % of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33 % of the late HOS patients.ConclusionThe protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

“…EPA counter-regulates leukocyte-mediated tissue injury and proinflammatory gene expression (15). It has been reported that nutritional management is important in HOI treatment (7,8). Recent studies have reported that ProSure™ (Abbot Japan Co., Ltd, Tokyo, Japan), an EPA-containing supplement, affects the nutritional status and quality of life in advanced cancer patients (17,18).…”

“…High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6)(7)(8).…”

Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

“…High output of enteric contents is a common sequela of both double enterostomy (DES) of the small bowel and a subtype of enterocutaneous fistula with an exposed external orifice, termed enteroatmospheric fistula (EAF) . High outputs are known to precede multiple complications including dehydration and renal impairment, electrolyte disturbances, malnutrition, and intestinal failure (IF) . Mortality has been reported to be as high as 30% in high‐output EAFs compared with 6% having low output …”

“…1 High outputs are known to precede multiple complications including dehydration and renal impairment, electrolyte disturbances, malnutrition, and intestinal failure (IF). [2][3][4] Mortality has been reported to be as high as 30% in high-output EAFs compared with 6% having low output. [5][6][7] Patients with high-output DES or EAF are commonly managed in the tertiary care setting, often as inpatients in specialist colorectal or IF units.…”

Systematic review: pharmacotherapy for high‐output enterostomies or enteral fistulas

“…In most cases, this is due to a high‐output ECF or enterostomy. Although different definitions are used in literature, generally an ECF producing over 500 mL/24 h or an enterostomy producing over 1500 mL/24 h is considered as high output. Three types of intestinal failure can be distinguished.…”