A Surgical Audit on Ileostomy- From Creation to Closure

Abstract

BACKGROUNDTemporary ileostomies are commonly used forms of faecal diversion. We wanted to study the various indications, complications, morbidity and mortality of ileostomy. METHODSAn analysis was performed of all patients who underwent ileostomy construction and reversal between June 2015 to October 2017, with data being collected prospectively in post-operative period and then patients are followed for next 12 weeks (average) before reversal. Later they were followed after reversal for next 12 weeks. RESULTSThirty patients, (21 male, 9 female) with a mean age of 46 years (range 15 to 60 years) had ileostomies constructed. Indications for ileostomy construction included traumatic ileal perforation (6), tuberculous ileal stricture (5), enteric ileal perforation (4), intestinal obstruction due to post-operative adhesions (4), obstructed hernia (3), caecal perforation (2), suspected Crohn's disease (2), tuberculous ileal perforation (1), ileovaginal fistula (1), anastomotic leak (1) and sigmoid volvulus (1). Complications like peristomal skin excoriation were noted in 26 patients, 7 patients had wound infection, 2 patients underwent resurgery one for stomal necrosis and other for post-operative adhesions. Death was reported in 3 patients. Mean time to ileostomy reversal was 9.6 weeks. Ileostomy was reversed in 26 patients. Among them, 10 patients had wound infection, diarrhea in 2 cases, resurgery was done in one case, enterocutaneous fistula was noted in one case, and one patient expired after reversal procedure. Diarrhoea was noted in one case in first follow up. Stitch abscess and incisional hernia were observed in 3 and 2 cases respectively. CONCLUSIONSThe present study states that considerable complications are associated with ileostomy, but the role of active intervention is minimal. Hence it can be stated that benefits outweigh the risks.

Single-Centre Retrospective Audit of Clostridium difficile Infections Post Ileostomy Reversal

“…Concurrent C. difficile infection in patients undergoing an ileostomy reversal has been associated with significant morbidity. These infections usually present asymptomatic or as loose stools, which makes the diagnosis of C. difficile infection challenging due to loose stools being a potentially expected symptom post reversal of ileostomy [ 6 ]. When severe, the C. difficile infection then progresses to fulminant colitis or toxic megacolon, which have significant morbidity and mortality [ 7 ].…”