Obstructive and secretory complications of diverting ileostomy

Table 1 Risk factors of obstructive complication of diverting ileostomy

Risk factors
Patient characteristics
Young age (less than 16 yr old)[11]
Low body mass index (less than 21 kg/m2)[11]
Thick subcutaneous fat at the stoma marking site (20 mm or more) [16]
Thick rectus abdominis muscle at the stoma passage (10 mm or more)[10,13]
Long distance between the superior mesenteric artery root and the bottom of the external anal sphincter (height-adjusted, 191 mm/m)[19]
Disease
Ulcerative colitis (compared with colorectal cancer)[15]
Surgical factors
Laparoscopic surgery (compared with open surgery)[18,22]
Rotation of stoma limb (180-degree rotation, the oral limb situated on the caudal side)[21]
Ileal-pouch anal anastomosis (compared with low anterior resection or intersphincteric resection)[12]
Two-stage surgery for ulcerative colitis[20]
Short distance from the ileal pouch to the stoma site (< 30 cm)[12,18]
Stoma functions
High output from stoma (2000 mL or more per day)[10,17]

Table 2 Causes and risk factors of high output stoma

Causes and risk factors of high output stoma
Patient
1Older age[42,48]
1Higher ASA-PS[48]
1Elevated baseline creatine[48]
Disease
1Diabetes[43]
Inflammatory bowel disease (i.e., ulcerative disease, Crohn’s disease)[29,42,43]
Anatomy
Short bowel (less than 200 cm)[29]
Surgical procedure
Open surgery (vs laparoscopic surgery)[42,48]
Total proctocolectomy (with ileal-pouch anal anastomosis)[42]
Right-side colectomy[42]
Separate ileostomy[42]
Small bowel resection[29,42,43]
Medication
Preoperative use of diuretics[31,33]
Prokinetic drugs (i.e., metoclopramide)[29,31]
Sudden withdrawal of corticosteroids or opiates[29,31]
Postoperative adjuvant chemotherapy[29]
Nutrition
Hypotonic liquids (low sodium): water, tea, coffee, fruit juice, alcohol[29,30,31]
Enteritis/metabolism
Clostridium difficile infection[29,50]
Salmonella infection[29,50]
Bacterial overgrowth from diverticula or blind loop fermentation[29,50]
Relative to postoperative complications
Postoperative ileus (symptoms of nausea, vomiting, intolerance to oral feeding, abdominal distension, or failure to pass flatus or bowel movements within postoperative 7 d)[44]
Intra-abdominal sepsis (pelvic sepsis, organ/space infection)[29,49]
Small bowel obstruction[29]
Stoma outlet obstruction[49]

¹No specific values or definitions were shown in the referenced articles. ASA-PS: American Society of Anesthesiologists-physical status.