The Pathology and Physiology of Ileostomy

Abstract

An ileostomy is a surgery that is commonly performed to protect low pelvic anastomoses or prevent high-risk anastomotic leakages. However, various postoperative complications remain of major concern. After an ileostomy, the distal intestinal segment is left open for an extended period and is in a non-functional state. Consequently, the intestinal mucosa, smooth muscle, and microbiota undergo significant changes that are closely related to postoperative recovery and complications. A systematic description of these changes is necessary to understand the relationship among them and take more effective measures for postoperative intervention.

Dissecting the effect of ileal faecal diversion on the intestine using single‐cell sequencing

“…This may stimulate the growth of pathogenic microbes. Additionally, significantly reduced T cells and IgA + B cells indicate reduced adaptive immunity 73,74 . Consequently, the defunctioned intestine has a high risk of infection.…”

“…The atrophy of the muscularis propria may be due to the absence of mechanical stimulation, leading to a loss of intestinal motility 70 . Dysbiosis of microbes in the defunctioned intestine also results in decline in intestinal motility, which has been reviewed previously 74 . These are risk factors for slow recovery and complications after reversal of faecal diversion, which need to be addressed.…”

“…Additionally, significantly reduced T cells and IgA + B cells indicate reduced adaptive immunity. 73 , 74 Consequently, the defunctioned intestine has a high risk of infection. Nevertheless, our data showed that the antimicrobial peptides of the epithelium in the defunctioned intestine were significantly increased, compensating for the defective function of the intestinal barrier.…”

Ileostomy: Early and Late Complications

“…Regardless of the underlying pathology, an ileostomy should aim to improve the quality of life of the patient with the least number of limitations possible. 1 Two types of ileostomies can be performed: loop and end ileostomy. Diverting or loop ileostomies are normally useful in cases in which a low anterior resection is required due rectal cancer, or in patients with ulcerative colitis who have undergone a restorative proctocolectomy with ileal pouch-anal anastomosis.…”

“…Be that as it may, more delayed complications should not be discarded. 1 6 7 Since they are noticeable, when present, these complications can have a huge impact on the mental health of the patients by lowering their self-esteem and altering their self-image. Thus, psychiatric disorders such as anxiety and depression may be found after hospitalization.…”