Copyright ©The Author(s) 2022.
World J Gastroenterol. Dec 21, 2022; 28(47): 6732-6742
Published online Dec 21, 2022. doi: 10.3748/wjg.v28.i47.6732
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]
  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
  1Older age[42,48]
  1Higher ASA-PS[48]
  1Elevated baseline creatine[48]
  Inflammatory bowel disease (i.e., ulcerative disease, Crohn’s disease)[29,42,43]
  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]
  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]
  Hypotonic liquids (low sodium): water, tea, coffee, fruit juice, alcohol[29,30,31]
  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]