Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

Abstract

SUMMARY Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of [1-14C] glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14C02-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12 there was evidence of a stagnant loop syndrome, as oral lincomycin treatment resulted in increased absorption of B12, decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.The continent ileostomy introduced by Kock (1969) is an alternative to the conventional ileostomy and makes use of an abdominal reservoir in which the intestinal contents are stored for several hours. Clinical studies have shown that the operation results in morphological changes in the reservoir with shortening of the villi as well as an increased number of microorganisms (Brandberg et al., 1972). It is, however, still uncertain whether the continent ileostomy leads to intestinal malabsorption. Jagenburg et al. (1971) found subnormal values of the Schilling test in six out of 10 patients with continent ileostomy, whereas the absorption of fat, d-xylose, and Lphenylalanine was the same as in patients with conventional ileostomy. In a subsequent study a low value in the Schilling test was found in only one patient of 34 with continent ileostomy , and it was shown that the mucous membrane of the reservoir retained its capacity to absorb d-xylose and phenylalanine .In this study we present evidence of malabsorption because of a stagnant loop syndrome in four out of seven patients with continent ileostomy.'Address for reprint requests: H. Schj0nsby, Medical Department A, 5016 Haukeland Hospital, Norway. Received for publication 23 March 1977 Methods PATIENTS Seven outpatients with a conventional ileostomy (four women and three men, age range 28-61 years) and seven outpatients with a continent ileostomy (one woman and six men, age range 20-51 years) were included in the study. The postoperative observation period in the patients with conventional ileostomy varied between one to 110 months (mean 36 months) and in the patients with continent ileostomy between six to 52 months (mean 36 months). The indication for proctocolectomy was ulcerative colitis. In one patient with a continent ileostomy 15 cm of the ileum had been resected. In all the other patients less than 10 cm of the ileum had been removed. All patients gave their informed consent to the study, and were on unrestricted diet.

Outcome after septic complications in J pouch procedures

“…There has been controversy as to whether repeated surgical attempts at pouch salvage are justi®ed 11,27,28 . The mean number of minor and major surgical procedures in all patients with septic complications registered in the present investigation was 2´2 per patient, similar to the ®ndings of earlier studies, in which mean numbers of 2´0, 2´4 and 2´9 3,11,24 were reported.…”

Dysfunction of the continent ileostomy: clinical features and bacteriology.

“…On restudy, these five still had excess outputs of volume (>1000 g/day) and/or fat (Table 1). Seven patients (nos [6][7][8][9][10][11][12] had symptoms of dysfunction of the pouch (Table 1); these included bleeding from the pouch, diarrhoea, peristomal discomfort, minor leakage, and difficulties with intubation. In five, the onset of symptoms was during the first year after 193 operation (range, one to nine months; mean, five ileostomies constructed 2() to 58 months (mean, 38 months).…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…The overall risk of pouchitis in continent ileostomy is 13–43% . Bacteriological studies of continent ileostomy have demonstrated significant bacterial overgrowth with Gram‐negative and anaerobic flora . Multiple enteroliths in Kock pouches have also been reported, probably resulting from the same mechanisms and causing abdominal pain and altered pouch function, but usually extractable by endoscopic means , although laser lithotripsy has also been reported .…”

“…The overall risk of pouchitis in continent ileostomy is 13-43% [511,512]. Bacteriological studies of continent ileostomy have demonstrated significant bacterial overgrowth with Gram-negative and anaerobic flora [511,[513][514][515].…”