Absorption studies in patients with `intraabdominal ileostomy reservoirs' and in patients with conventional ileostomies

Jagenburg, Rudolf; Dotevall, G; Kewenter, J; Kock, N. G.; Philipson, B. M.

doi:10.1136/gut.12.6.437

Cited by 36 publications

(6 citation statements)

References 13 publications

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“…It is, however, still uncertain whether the continent ileostomy leads to intestinal malabsorption. Jagenburg et al (1971) found subnormal values of the Schilling test in six out of 10 patients with continent ileostomy, whereas the absorption of fat, d-xylose, and Lphenylalanine was the same as in patients with conventional ileostomy. In a subsequent study a low value in the Schilling test was found in only one patient of 34 with continent ileostomy , and it was shown that the mucous membrane of the reservoir retained its capacity to absorb d-xylose and phenylalanine .…”

mentioning

confidence: 76%

Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

Schjønsby¹,

Halvorsen²,

Hofstad³

et al. 1977

Gut

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SUMMARY Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of [1-14C] glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14C02-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12 there was evidence of a stagnant loop syndrome, as oral lincomycin treatment resulted in increased absorption of B12, decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.The continent ileostomy introduced by Kock (1969) is an alternative to the conventional ileostomy and makes use of an abdominal reservoir in which the intestinal contents are stored for several hours. Clinical studies have shown that the operation results in morphological changes in the reservoir with shortening of the villi as well as an increased number of microorganisms (Brandberg et al., 1972). It is, however, still uncertain whether the continent ileostomy leads to intestinal malabsorption. Jagenburg et al. (1971) found subnormal values of the Schilling test in six out of 10 patients with continent ileostomy, whereas the absorption of fat, d-xylose, and Lphenylalanine was the same as in patients with conventional ileostomy. In a subsequent study a low value in the Schilling test was found in only one patient of 34 with continent ileostomy , and it was shown that the mucous membrane of the reservoir retained its capacity to absorb d-xylose and phenylalanine .In this study we present evidence of malabsorption because of a stagnant loop syndrome in four out of seven patients with continent ileostomy.'Address for reprint requests: H. Schj0nsby, Medical Department A, 5016 Haukeland Hospital, Norway. Received for publication 23 March 1977 Methods PATIENTS Seven outpatients with a conventional ileostomy (four women and three men, age range 28-61 years) and seven outpatients with a continent ileostomy (one woman and six men, age range 20-51 years) were included in the study. The postoperative observation period in the patients with conventional ileostomy varied between one to 110 months (mean 36 months) and in the patients with continent ileostomy between six to 52 months (mean 36 months). The indication for proctocolectomy was ulcerative colitis. In one patient with a continent ileostomy 15 cm of the ileum had been resected. In all the other patients less than 10 cm of the ileum had been removed. All patients gave their informed consent to the study, and were on unrestricted diet.

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mentioning

confidence: 76%

Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

Schjønsby¹,

Halvorsen²,

Hofstad³

et al. 1977

Gut

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“…We have not performed absorption studies in our patients, but none of them has hitherto shown any clinical signs of deficiencies. Jagenburg et al (1971) studied the absorption of D-xylose, fat and L-phenylalanine in 10 patients with a conventional ileostomy and in 10 patients with an ileal intra-abdominal reservoir, and found no differences in the two groups. The bacterial flora of the reservoir is intermediate between the flora of the effluent from a conventional ileostomy and that of normal faeces (Branberg et al, 1972).…”

Section: Discussionmentioning

confidence: 99%

The continent ileostomy of Kock (ileal intra-abdominal reservoir)

Halvorsen

Heimann

1975

Journal of British Surgery

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“…However, the ability of the intestines of these patients to absorb L-phenylalanine, D-xylose, fat, and vitamin B12 is the same as that of patients with conventional ileostomies (Jagenburg, Dotevall, Kewenter, Kock, and Philipson, 1971;Jagenburg, Kock, and Philipson, 1975). In spite of the presence of an increased number of microorganisms (Brandberg, Kock, and Philipson, 1972;Philipson et al, 1975), local vitamin B12 absorption has been demonstrated in the reservoirs of some patients .…”

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confidence: 92%

Function and structure of the mucosa of continent ileostomy reservoirs in dogs.

Philipson¹,

Kock²,

Robinson³

et al. 1975

Gut

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SUMMARY Continent ileostomy reservoirs were constructed in dogs. Nine to 29 days after formation of the pouches, they were excised together with a loop of adjacent ileum for biochemical and morphological assessment. The villous and epithelial cell heights were reduced, whereas villous width and mitotic index were increased. The mucosa of the pouch was able to absorb phenylalanine and f-methyl-glucoside against a concentration gradient, although this absorptive capacity was lower than that of normal ileum. Similar considerations applied to oxygen consumption. The results indicate that the mucosa of the pouch undergoes transformation, but the integrity of the epithelial layer is maintained.Recently a 'continent ileostomy' was devised (Kock, 1969(Kock, , 1973Kock, Darle, Kewenter, Myrvold, and Philipson, 1974) and introduced as an alternative to the conventional ileostomy in man. The continent ileostomy utilizes an intraabdominal reservoir constructed from the distal ileum for collection and temporary storage of the intestinal contents.Clinical follow-up studies in patients with continent ileostomies have revealed morphological changes in the mucosa of the intraabdominal reservoir, which included decreased villous height and increased epithelial turnover (Philipson, Brandberg, Jagenburg, Kock, Lager, and Ahrdn, 1975). However, the ability of the intestines of these patients to absorb L-phenylalanine, D-xylose, fat, and vitamin B12 is the same as that of patients with conventional ileostomies (Jagenburg, Dotevall, Kewenter, Kock, and Philipson, 1971;Jagenburg, Kock, and Philipson, 1975). In spite of the presence of an increased number of microorganisms (Brandberg, Kock, and Philipson, 1972;Philipson et al, 1975), local vitamin B12 absorption has been demonstrated in the reservoirs of some patients The absorptive capacity of the mucosa used for the construction of the reservoir is difficult to study in vivo under standardized conditions. For this reason, animal experiments have been performed to estimate in vitro the transport of amino acids and sugars by the mucosa of the reservoir. Materials and Methods SURGICAL PROCEDURENineteen mongrel dogs of both sexes weighing 9-5-17-5 kg were used. Paramedian laparotomy was performed under pentobarbital anaesthesia and sterile conditions. The ileum was divided about 7 cm from the ileocaecal valve, and the distal stump of ileum was closed. The construction of the ileostomy reservoir corresponded exactly to that described previously for clinical use (Kock, 1973). Briefly, a loop of ileum was formed into a U, the walls of the U were sewn together, and the loop was opened longitudinally. The terminal unsplit segment was employed for the construction of the nipple valve. Then the bottom of the U was folded up and the free edges were sewn together to form a hermetic pouch. The completed pouch was then placed in the abdomen and fixed in position. The outlet was passed through the abdominal wall by means of a separate incision and an ileostomy was created.Before closure of the a...

show abstract

Absorption studies in patients with `intraabdominal ileostomy reservoirs' and in patients with conventional ileostomies

Cited by 36 publications

References 13 publications

Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).

The continent ileostomy of Kock (ileal intra-abdominal reservoir)

Function and structure of the mucosa of continent ileostomy reservoirs in dogs.

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