Causes and management of a high-output stoma

Baker, Melanie; Williams, R.; Nightingale, J. M. D.

doi:10.1111/j.1463-1318.2009.02107.x

Cited by 184 publications

(209 citation statements)

References 26 publications

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“…There are existing guidelines and algorithms regarding treatment of high output stomas. [23,24] For example, one algorithm for treatment of high output stomas (greater than 2000ml/24 hours for 3 or more consecutive days) is broken into 3 stages: 1) identify causes of high output (sepsis, SBO, medications, infectious colitis, etc. ); 2) progression through use of medications to decrease output; 3) intravenous fluids to rehydrate the patient.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

et al. 2013

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Background Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. Our purpose was to evaluate the impact of ileostomy related complications on the treatment of rectal cancer. Methods A retrospective cohort study of patients who underwent sphincter preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy. Statistical analyses were performed with STATA 12. Results A total of 294 patients were analyzed, 32% (n=95) were women. Two hundred seventy-one (92%) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 centimeters (interquartile range 5-10). Two hundred eighty-one (96%) underwent stoma closure at a median 7 months (interquartile range 5.4 – 8.3). The most common complication related to readmission was dehydration (n=32, 11%). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (OR 3.01, 95% CI 1.42-6.38, p=0.004). Conclusion Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits.

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Section: Discussionmentioning

confidence: 99%

Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

et al. 2013

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“…High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Fujino

Miyoshi

Ohue

et al. 2017

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to examine the risk factors of high-output ileostomy (HOI), which is associated with electrolyte abnormalities and/or stoma complications, and to create a prediction model. The medical records of 68 patients who underwent colorectal cancer surgery with ileostomy between 2011 and 2016 were retrospectively investigated. All the patients underwent surgical resection for colorectal cancer at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan). A total of 7 patients with inadequate data on ileostomy output were excluded. Using a group of 50 patients who underwent surgery between 2011 and 2013, the risk of HOI was classified by a decision tree model using a partition platform. The HOI prediction model was validated in an additional group of 11 patients who underwent surgery between 2014 and 2016. Univariate analysis of clinical factors demonstrated that young age (P=0.003) and high white blood cell (WBC) count (P<0.001) after surgery were significantly correlated with HOI. Operative factors, such as surgical procedure, approach, operative time and blood loss, were not significantly correlated with HOI. Using these clinical factors, the risk of HOI was classified by statistical partition. In this model, three factors (gender, age and WBC on postoperative day 1) were generated for the prediction of HOI. The patients were classified into five groups, and HOI was observed in 0-88% of patients in each group. The area under the curve (AUC) was 0.838. The model was validated by an external dataset in an independent patient group, for which the AUC was 0.792. In conclusion, HOI patients were classified and an HOI prediction model was developed that may help clinicians in postoperative care. IntroductionSurgery is an effective treatment for colorectal cancer (CRC) (1,2), and certain procedures, such as low anterior resection and intersphincteric resection for lower rectal cancer, require an ileostomy to reduce the risk of severe anastomotic leakage (3-5). High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6-8).The aim of the present study was to determine the frequency and risk factors of HOI and to create a prediction model of HOI. Predicting HOI may be useful for perioperative treatment. Patients and methodsPatients and data sets. A total of 68 consecutive patients who underwent surgery for colorectal cancer with ileostomy at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) between 2011 and 2016 were retrospectively analyzed. HOI was defined by a maximum output of >2,000 ml/day and high output (>1,000 ml/day) lasting for >3 days (Fig. 1). A total of 7 patients for whom detailed data of output were unavailable were excluded (Fig. 2). Based on a group of 50 patients who underwent surgery between 2011 and 2013, a decision tree was used to develop a prediction model for HOI. Clinicopathological factors, such as patient sex, age, body mass index, tumor stage, pr...

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“…16% of patients with a small bowel stoma have problems with high stoma output (more than 2 L stomal output/day) in the first 3 weeks following surgery, and 27% of these need long-term treatment 4. High-output ileostomies are problematic, not only causing water and electrolyte disturbance but also the psychological and practical difficulties of managing a high-output stoma 3…”

Section: Discussionmentioning

confidence: 99%

Successful management of chronic high-output ileostomy with high dose loperamide

2015

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High-stoma output is a common problem that can lead to dehydration and electrolyte disturbance. The following report describes three patients with end ileostomy who had high-stoma outputs where conventional medical management was unsuccessful in controlling stoma output. All three patients responded to high-dose loperamide, resulting in significant clinical improvement. High-dose loperamide therapy should be considered in patients with high-stoma output who have failed conventional medical management.

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Causes and management of a high-output stoma

Abstract: Early high output from an ileostomy is common and although 49% resolved spontaneously, 51% needed ongoing medical treatment, usually because of a short small-bowel remnant.

Cited by 184 publications

References 26 publications

Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Successful management of chronic high-output ileostomy with high dose loperamide

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