Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Abstract

Objective. The present study was carried out with an aim to study the nutritional status of patients undergoing emergency ileostomy using simple bedside tools in a developing country. Methods. Nutritional assessment (anthropometry, biochemical, immunological, and dietary) was done within 24-36 hours of admission and 6 weeks postoperatively. Primary endpoint was the study of the nutritional status of the patients with ileostomy. Results. N = 58, 47 males with mean age 32 years. Postoperatively 50 (86.2%) patients experienced some complications including those related to ileostomy. Malnutrition varied from 7 (12.1%) using BMI to 54 (93.1%) by triceps skinfold thickness. At 6 weeks, despite adequate nutritional intake, there was a significant decrease in almost all nutritional parameters except serum albumin which was normal in most patients. Factors contributing to weight loss in 41 (70.7%) patients were decreased length of proximal bowel left (P = 0.001), increased ileostomy output (P = 0.001), delayed surgery (P = 0.004), and increased disease severity score (P = 0.005). Conclusion. Majority of patients undergoing emergency ileostomy were malnourished and had significant nutritional depletion despite adequate nutritional support. Serial assessment helps to assess nutritional recovery in these patients.

Can Postoperative Nutrition be Favourably Maintained by Oral Diet in Patients with Emergency Temporary Ileostomy? A Tertiary Hospital Based Study

“…Created in the emergency setting of perforation or gangrene with peritonitis, temporary ileostomy is lifesaving. It enables individuals to enjoy normal activities even though they have a stoma [1][2][3][4][5]. Nutritional depletion occurs in patients with ileostomy due to both anatomical and functional loss of gut, ongoing inflammatory activity due to disease with sepsis, pre-existing malnutrition and the added surgical stress.…”

“…Once oral nutrition was started, intravenous fluids were discontinued. An individualized diet chart was formulated for each patient using Harris-Benedict Equation [1]. Oral diet was at first restricted to clear liquids.…”

“…These patients generally have septic peritonitis with fecal contamination and unhealthy bowel [1][2][3][4][5]. Ileostomy results in gross impairment of absorptive capacity in the postoperative period with increased stomal loss of fluids and electrolytes.…”

“…The patients have an inappropriate food intake due to physical morbidity and emotional trauma. Therefore, they suffer from chronic dehydration, gross malnutrition, impaired immunity and deranged body function [1][2][3][4]. It is thus a challenge for the surgeon to provide appropriate and adequate nourishment in presence of catabolism and sepsis.…”

“…It is thus a challenge for the surgeon to provide appropriate and adequate nourishment in presence of catabolism and sepsis. Oral nutrition is preferable as it is physiologic, cost effective with fewer complications [1,2].…”