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.
An ileostomy is associated with multiple complications that may frequently or persistently affect the life of ostomates. All healthcare professionals should have knowledge of the diagnosis, treatment, and prevention of ileostomy complications. Peristomal dermatitis is caused by watery and highly alkaline effluent. Skin protective products are typically used for local treatment. Ischemia/necrosis occurs due to insufficient arterial blood supply. Retraction is seen in patients with a bulky mesentery and occurs following ischemia. Convex stoma appliances can be used for skin protection against fecal leakage. Small bowel obstruction (SBO) is common and occurs only at the stoma site. Trans-stomal decompression is most effective in these cases. High output stoma (HOS) is defined as a condition when the output exceeds 1,000 - 2,000 ml/day, lasting for one to three days. Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs. Stomal prolapse is a full-thickness protrusion of an inverted bowel. Manual reduction is attempted initially, whereas emergency bowel resection may be needed for incarcerated cases. A parastomal hernia (PSH) is an incisional hernia of the stoma site. Surgery is considered in cases of incarceration, but most cases are manageable with non-surgical treatment.
Lymphoepithelioma-like carcinoma (LELC) can occur in many organs such as lung, stomach, skin, breast, bile ducts, esophagus, and other many organs. Esopahageal lymphoepithelioma-like carcinoma is an extremely rare disease. LELC has been reported to be associated with Epstein-Barr virus (EBV) in some organs, although there are many controversies. Here, we report a surgically treated two cases of non-Epstein-Barr virus associated LELC of the esophagus. Case 1was a 46-year-old woman who was presented epigastralgia while eating. Upper gastrointestinal endoscopy showed a submucosal tumor in the lower esophagus. Biopsies were taken, and they identified atypical cells proliferating follicular manner and heavy infiltration of lymphocytes. Case 2 was a 71-year-old man who was pointed out to have a tumor in the esophagus by barium examination and was referred to our hospital. Upper gastrointestinal endoscopy showed submucosal tumor was found 23-26 cm from the cut tooth. Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) was performed and diagnosed with LELC. These patients underwent subtotal esophagectomy with lymphadenectomy and reconstruction with gastric tube. Case1 was pathologically diagnosed with LELC, SM3, INFa, ly0, V0, pIM0, pPM0 (100mm), pDM0 (120mm), pRM0, pN0, cM0, pStageI, and case2 was diagnosed with LELC, ly1, V1, pIM0, pPM0, pDM0, pRM0, pN0, cM0, pStageI, according to the 10th edition of Japanese classification of Esophageal cancer. Immunohistochemical staining of the specimen from case 1 was positive for AE1/AE3, P40, p63, and negative for CD56 and chromogranin A. Immunohistochemical staining of the specimen from case 2 was positive for CK, EMA, P40, and negative forαSMA and desmin. EBV was not detected by EBER in situ hybridization in the specimen from both patients. LELC is relatively common in salivary glands, thymus, lungs, stomach, skin, and cervix, and EBV that directly infects epithelial cells or infects lymphocytes infects epithelial cells and infects them. EBV infects epithelial cells and is thought to be associated with carcinogenesis of these organs. However, esophageal LELC is rare and it has been argued that EBV may not be involved. In these two cases, EBV was not detected in situ hybridization.
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