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Problems with
ileostomies
Mr Paul S Rooney
Colorectal surgeon
Royal Liverpool Hospital
ileostomy
End (Brown 1930)
Everted (Brooke 1952)
Loop (Turnbull 1961)
Generic Problems
Eczema
Poor seal
Sweating
Hygiene
Psychological (unnecessary changing)
Physical and metabolic
Physical problems
Retraction
Ischaemia
Necrosis
Abscess
Fistula
Recurrent disease
Bleeding
Hernia
Pyoderma
Everting wrong end
Tension,obesity
Iatrogenic
Crohns,Cancer
Varicies
negligence
Varices
Portal hypertension
ALD
Sclerosing cholangitis
Liver mets
Treatment
Injection of sclerosant , phenol,alcohol.
Needs repeat every 6weeks (Major 86)
Muco-cutaneous disconnection easy!
20% recurrence in 30 months (Beck 88)
Hernia
10-40%
20% require surgery (pain,obstruction etc)
Repair by non absorbables 50% recurrence
rate.(Allen-Mersh (1988)
Mesh or Move?
Heamatoma
Infection
Erosion
Low recurrence
rate<1%@5y (Bokey
2003)
Laporotomy risk?
Poorly sited likely to
benefit
Decision depends on
patient factors and number
of previous repairs
ileostomy Flux
Normal 3-800ml/day
>10cm resection significantly increases
flow
Infection
Radiation
Crohns, cancer
Obstruction 4-5l/day!
Flux
Losses of >1L need replacing as saline
1.5l need admitting
Can fatally induce Addisonian crisis
100mg hydrocortisone qds (lifesaving)
Renal failure
Somatostatin PPI’s
Metabolic
Chronic dehydration
Anaemia ,low ferritin
Low B12, Na, K
Urate and calcium stones
Gall stones (loss of bile salts)
Closure
V easy or VV Hard
Try to avoid early closure wait 6 weeks at
least
50% complication rate inc death!
No one way of closure appears to be best
(Hosie 1991)
Stoma problems:
Retraction
Excoriation
Prolapse
Necrosis