An unusual cause for small bowel obstruction as a complication of an ileostomy formation

Abstract

Ileostomy formation is a fundamental component in the surgical management of many gastrointestinal diseases and like all intra-abdominal surgeries, small bowel obstruction is a recognized complication. In this paper we discuss a case of a 44-year-old female who previously had a loop ileostomy for slow bowel transit in the presence of spinal bifida. She presented for subsequent total colectomy because of ongoing pain due to chronic colonic dilation. At surgery, the stoma was not revised and the efferent loop was divided at the peritoneal level of the anterior abdominal wall. Six days postoperatively, the patient developed a small bowel obstruction as a result of the remnant efferent loop within the anterior abdominal wall, forming a cystic mass compressing the ileostomy, requiring surgical intervention. As far as we are aware, this is the first case of small bowel obstruction described due to this unusual etiology.

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review

“…The mean age was 40.9 years (range, 7 months-60 years) and 21% of patients were male (Table 1) [2,[8][9][10][11][12][13]. The majority (70%) of the included patients presented to the emergency department with abdominal pain and distension, whereas no patients presented with hemodynamic instability or septic shock.…”

“…Once ileostomy volvulus was diagnosed, low anterior resection with ileostomy was reported in 10.6% of patients, while ileal resection was reported in 3.6%. One case reported outlet obstruction after total colectomy [2]. Ileostomy and colostomy were surgically performed in most patients (90%), with ileostomy along with proctocolectomy performed in 2 patients.…”

“…Table 2 shows the assessment of the methodological quality of included studies [2,[8][9][10][11][12][13]. Most included studies did not mention whether the reported cases represented the full experience of their centers; however, most other domains were consistently addressed.…”

“…It most often occurs at the sigmoid colon and caecum, and volvulus accounts for 5% of bowel obstructions in developed countries. Small bowel volvulus is an extremely rare complication, with a reported incidence of 1 to 5 cases per 100,000 in the developed world [1][2][3].…”

“…Ulcerative colitis (UC) is a chronic inflammatory bowel disease, and stoma formation is required in 4% of UC patients within 5 years of diagnosis [2,5]. This case report presents a 44-year-old woman with UC who had a recent ileostomy complicated by SBO secondary to volvulus with no adhesion formation.…”