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World J Gastroenterol. Dec 21, 2022; 28(47): 6732-6742
Published online Dec 21, 2022. doi: 10.3748/wjg.v28.i47.6732
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, Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
Author contributions: Tsujinaka S wrote the manuscript; Suzuki H, Miura T and Sato Y reviewed the manuscript and agreed with submission; Shibata C critically reviewed the manuscript and agreed with submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shingo Tsujinaka, MD, Associate Professor, Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai 983-8536, Miyagi, Japan. tsujinakas@tohoku-mpu.ac.jp
Received: September 20, 2022
Peer-review started: September 20, 2022
First decision: October 21, 2022
Revised: November 4, 2022
Accepted: November 25, 2022
Article in press: November 25, 2022
Published online: December 21, 2022
Processing time: 89 Days and 22 Hours
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: Small bowel obstruction; Stoma outlet obstruction; Stoma-related obstruction; High output stoma; High output syndrome; Dehydration

Core Tip: This review highlights the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site (stoma outlet obstruction/stoma-related obstruction, SOO/SRO) affect 5.4%-27.3% of patients with DI. Trans-stomal tube decompression is effective in most cases. Surgical refinement is important for reducing SOO/SRO. Secretory complications (high output stoma, HOS) lead to water and sodium depletion and secondary hyperaldosteronism with electrolyte imbalances. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d. HOS treatment includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs may decrease the readmission rates for dehydration.