Diagnosis, Treatment, and Prevention of Ileostomy Complications: An Updated Review

Abstract

An ileostomy is associated with multiple complications that may frequently or persistently affect the life of ostomates. All healthcare professionals should have knowledge of the diagnosis, treatment, and prevention of ileostomy complications. Peristomal dermatitis is caused by watery and highly alkaline effluent. Skin protective products are typically used for local treatment. Ischemia/necrosis occurs due to insufficient arterial blood supply. Retraction is seen in patients with a bulky mesentery and occurs following ischemia. Convex stoma appliances can be used for skin protection against fecal leakage. Small bowel obstruction (SBO) is common and occurs only at the stoma site. Trans-stomal decompression is most effective in these cases. High output stoma (HOS) is defined as a condition when the output exceeds 1,000 - 2,000 ml/day, lasting for one to three days. Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs. Stomal prolapse is a full-thickness protrusion of an inverted bowel. Manual reduction is attempted initially, whereas emergency bowel resection may be needed for incarcerated cases. A parastomal hernia (PSH) is an incisional hernia of the stoma site. Surgery is considered in cases of incarceration, but most cases are manageable with non-surgical treatment.

Acute stomal necrosis, conservative management. Case report and literature review

“…(17) When opting for conservative treatment, one must be cautious because the necrosis could be self-limiting in the first hours, either to the mucosa or transmurally to the entire intestine in question and may extend to below the fascia, despite the fact that In the initial evaluation, it does not present below this, for this reason, in case of suspicion of ischemia of the ostomy, an examination of this should be carried out at least twice a day. (18).…”

Predicting bowel function after diverting stoma closure in patients with rectal cancer

“…A diverting stoma can effectively prevent potential or even life-threatening clinical consequences, such as anastomotic leakage, especially in patients with mid-to-low rectal cancer after radical resection ( 1 , 2 ). However, it carries risks such as infection, ulceration, parastomal hernias, stomal obstruction and even psychological disorders ( 3 - 8 ). Patients frequently require regular follow-up at a wound ostomy clinic to monitor the stoma and ensure their overall well-being.…”