Obstructive and secretory complications of diverting ileostomy

Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata, Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata

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.

Keywords: Dehydration; High output stoma; High output syndrome; Small bowel obstruction; Stoma outlet obstruction; Stoma-related obstruction.

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Computed tomography shows stenosis at the ileostomy site (arrowheads).
Figure 2
Figure 2
Contrast enema study shows a decompression tube inserted at the stenotic stomal opening (arrow) and dilated small bowel proximal to the stoma site (arrowheads).

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