Download PDF
CC BY 4.0 · Journal of Coloproctology 2024; 44(01): e80-e86
DOI: 10.1055/s-0044-1779603
Review Article

Ileostomy: Early and Late Complications

Francisco Duarte Cerqueira Gomes Girão Santos 
1   Surgery Department, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
,
Laura Elisabete Ribeiro Barbosa 
1   Surgery Department, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
2   Department of General Surgery, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
,
João Paulo Meireles de Araújo Teixeira 
1   Surgery Department, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
2   Department of General Surgery, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Introduction Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases.

Materials and Methods We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review.

Results/Discussion Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation.

Conclusion Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor.

Keywords

ileostomy - loop ileostomy - end ileostomy - stoma complications


Publication History

Received: 20 March 2023

Accepted: 10 January 2024

Article published online:
11 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Ma H, Li X, Yang H, Qiu Y, Xiao W. The Pathology and Physiology of Ileostomy. Front Nutr 2022; 9: 842198
    CrossrefPubMedGoogle Scholar
  • 2 Amiot A, Gornet JM, Baudry C. et al. Crohn's disease recurrence after total proctocolectomy with definitive ileostomy. Dig Liver Dis 2011; 43 (09) 698-702
    CrossrefPubMedGoogle Scholar
  • 3 Fonseca T, Campos E, Castro MM, Costa S, Azevedo A, Barbosa E. Defunctioning loop ileostomy in rectal cancer surgery: The experience of a referral center. Rev Port Cir 2022; 2 (53) 27-36
    Google Scholar
  • 4 Tsujinaka S, Suzuki H, Miura T, Sato Y, Shibata C. Obstructive and secretory complications of diverting ileostomy. World J Gastroenterol 2022; 28 (47) 6732-6742
    CrossrefPubMedGoogle Scholar
  • 5 Pandiaraja J, Chakkarapani R, Arumugam S. A study on patterns, indications, and complications of an enteric stoma. J Family Med Prim Care 2021; 10 (09) 3277-3282
    CrossrefPubMedGoogle Scholar
  • 6 Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12 (10) 958-964
    CrossrefPubMedGoogle Scholar
  • 7 Babakhanlou R, Larkin K, Hita AG, Stroh J, Yeung SC. Stoma-related complications and emergencies. Int J Emerg Med 2022; 15 (01) 17
    CrossrefPubMedGoogle Scholar
  • 8 Tripaldi C. Sexual function after stoma formation in women with colorectal cancer. Br J Nurs 2019; 28 (16) S4-S15
    CrossrefPubMedGoogle Scholar
  • 9 Krishnamurty DM, Blatnik J, Mutch M. Stoma Complications. Clin Colon Rectal Surg 2017; 30 (03) 193-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Bafford AC, Irani JL. Management and complications of stomas. Surg Clin North Am 2013; 93 (01) 145-166
    CrossrefPubMedGoogle Scholar
  • 11 Baker ML, Williams RN, Nightingale JMD. Causes and management of a high-output stoma. Colorectal Dis 2011; 13 (02) 191-197
    CrossrefPubMedGoogle Scholar
  • 12 Baker M, Greening L. Practical management to reduce and treat complications of high-output stomas. Gastrointest Nurs 2009; 7 (06) 10-17
    CrossrefGoogle Scholar
  • 13 Liu C, Bhat S, O'Grady G, Bissett I. Re-admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre. ANZ J Surg 2020; 90 (09) 1621-1626
    CrossrefPubMedGoogle Scholar
  • 14 Liu C, Bhat S, Sharma P, Yuan L, O'Grady G, Bissett I. Risk factors for readmission with dehydration after ileostomy formation: A systematic review and meta-analysis. Colorectal Dis 2021; 23 (05) 1071-1082
    CrossrefPubMedGoogle Scholar
  • 15 Arenas Villafranca JJ, López-Rodríguez C, Abilés J, Rivera R, Gándara Adán N, Utrilla Navarro P. Protocol for the detection and nutritional management of high-output stomas. Nutr J 2015; 14 (01) 45
    CrossrefPubMedGoogle Scholar
  • 16 Steinhagen E, Colwell J, Cannon LM. Intestinal Stomas-Postoperative Stoma Care and Peristomal Skin Complications. Clin Colon Rectal Surg 2017; 30 (03) 184-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Maeda S, Ouchi A, Komori K. et al. Risk factors for peristomal skin disorders associated with temporary ileostomy construction. Surg Today 2021; 51 (07) 1152-1157
    CrossrefPubMedGoogle Scholar
  • 18 Maglio A, Malvone AP, Scaduto V, Brambilla D, Denti FC. The frequency of early stomal, peristomal and skin complications. Br J Nurs 2021; 30 (22) 1272-1276
    CrossrefPubMedGoogle Scholar
  • 19 O'Flynn SK. Care of the stoma: complications and treatments. Br J Community Nurs 2018; 23 (08) 382-387
    CrossrefPubMedGoogle Scholar
  • 20 Zwiep TM, Helewa RM, Robertson R. et al; Canadian Society of Colon and Rectal Surgeons and Nurses Specialized in Wound, Ostomy and Continence Canada preoperative stoma marking position statement task force. Preoperative stoma site marking for fecal diversions (ileostomy and colostomy): position statement of the Canadian Society of Colon and Rectal Surgeons and Nurses Specialized in Wound, Ostomy and Continence Canada. Can J Surg 2022; 65 (03) E359-E363
    CrossrefPubMedGoogle Scholar
  • 21 Wu XR, Mukewar S, Kiran RP, Remzi FH, Hammel J, Shen B. Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease. J Crohn's Colitis 2013; 7 (05) e171-e177
    CrossrefPubMedGoogle Scholar
  • 22 Afifi L, Sanchez IM, Wallace MM, Braswell SF, Ortega-Loayza AG, Shinkai K. Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review. J Am Acad Dermatol 2018; 78 (06) 1195-1204.e1
    CrossrefPubMedGoogle Scholar
  • 23 Wang J, Prenner J, Wang W. et al. Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51 (12) 1365-1372
    CrossrefPubMedGoogle Scholar
  • 24 Hughes AP, Jackson JM, Callen JP. Clinical features and treatment of peristomal pyoderma gangrenosum. JAMA 2000; 284 (12) 1546-1548
    CrossrefPubMedGoogle Scholar
  • 25 Toh JWT, Young CJ, Rickard MJFX, Keshava A, Stewart P, Whiteley I. Peristomal pyoderma gangrenosum: 12-year experience in a single tertiary referral centre. ANZ J Surg 2018; 88 (10) E693-E697
    PubMedGoogle Scholar
  • 26 Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg 2019; 32 (03) 176-182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Kwiatt M, Kawata M. Avoidance and management of stomal complications. Clin Colon Rectal Surg 2013; 26 (02) 112-121
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Strong SA. The Difficult Stoma: Challenges and Strategies. Clin Colon Rectal Surg 2016; 29 (02) 152-159
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Speirs M, Leung E, Hughes D. et al. Ileostomy rod–is it a bridge too far?. Colorectal Dis 2006; 8 (06) 484-487
    CrossrefPubMedGoogle Scholar
  • 30 Kim JT, Kumar RR. Reoperation for stoma-related complications. Clin Colon Rectal Surg 2006; 19 (04) 207-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Whiteley I, Russell M, Nassar N, Gladman MA. Outcomes of support rod usage in loop stoma formation. Int J Colorectal Dis 2016; 31 (06) 1189-1195
    CrossrefPubMedGoogle Scholar
  • 32 Mohan HM, Pasquali A, O'Neill B, Collins D, Winter DC. Stoma rods in abdominal surgery: a systematic review and metaanalyses. Tech Coloproctol 2019; 23 (03) 201-206
    CrossrefPubMedGoogle Scholar
  • 33 Ohira G, Miyauchi H, Hayano K. et al. Incidence and risk factor of outlet obstruction after construction of ileostomy. J Anus Rectum Colon 2018; 2 (01) 25-30
    CrossrefPubMedGoogle Scholar
  • 34 Sasaki S, Nagasaki T, Oba K. et al. Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today 2021; 51 (03) 366-373
    CrossrefPubMedGoogle Scholar
  • 35 Tamura K, Matsuda K, Yokoyama S. et al. Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction. Int J Colorectal Dis 2019; 34 (06) 1141-1145
    CrossrefPubMedGoogle Scholar
  • 36 Okada S, Hata K, Emoto S. et al. Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch-anal anastomosis: a retrospective cohort study. Surg Today 2018; 48 (12) 1060-1067
    CrossrefPubMedGoogle Scholar
  • 37 Güenaga KF, Lustosa SAS, Saad SS, Saconato H, Matos D. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis. Acta Cir Bras 2008; 23 (03) 294-303
    CrossrefPubMedGoogle Scholar
  • 38 Mittal R, Jalouta T, Luchtefeld M, Ogilvie Jr J. Surgical management of stomal prolapse - Is there a superior approach to repair?. Am J Surg 2020; 220 (04) 1010-1014
    CrossrefPubMedGoogle Scholar
  • 39 Maeda K. Prolapse of intestinal stoma. Ann Coloproctol 2022; 38 (05) 335-342
    CrossrefPubMedGoogle Scholar
  • 40 Styliński R, Alzubedi A, Rudzki S. Parastomal hernia - current knowledge and treatment. Wideochir Inne Tech Malo Inwazyjne 2018; 13 (01) 1-8
    PubMedGoogle Scholar
  • 41 Pu YW, Yang XD, Gong W, Xing CG. Etiological analysis of parastomal hernia by computed tomography examination. Wideochir Inne Tech Malo Inwazyjne 2019; 14 (03) 387-393
    PubMedGoogle Scholar
  • 42 Śmietański M, Szczepkowski M, Alexandre JA. et al. European Hernia Society classification of parastomal hernias. Hernia 2014; 18 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 43 Antoniou SA, Agresta F, Garcia Alamino JM. et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2018; 22 (01) 183-198
    CrossrefPubMedGoogle Scholar