Ileostomy diarrhea: Pathophysiology and management

Abstract

Ileostomy is a common component of surgical treatments for various gastrointestinal conditions. Loss of the fluid absorptive capacity of the colon results in increased fluid and electrolyte losses, which causes a state of relative fluid depletion. These losses can be offset in part by increased oral intake, but the remaining small intestine also compensates by increasing the efficiency of fluid and electrolyte absorption, a process termed adaptation, which occurs within weeks to months of ileostomy creation. Some patients fail to adapt adequately and have high ileostomy outputs from the time of surgery. Others with a previously well-adapted ileostomy may encounter periods of sustained high output when some additional process causes diarrhea. Many patients experience periods of high output after ileostomy creation and often require hospital readmission for this reason. Any patient with an ileostomy is at great risk of dehydration and electrolyte depletion should output rise dramatically. Prompt attention should be given to rehydration and identification of the underlying cause so that directed therapies may be implemented. This review discusses the alteration of normal intestinal fluid balance from colectomy with ileostomy, proposed mechanisms for adaptation, the differential diagnosis of ileostomy diarrhea, the evaluation of ileostomy diarrhea, and current treatment options.

Disfunción Ileostómica en Pacientes Sometidos a Resección Anterior Baja Por Un Cáncer Del Recto Luego De Neoadyuvancia

“…Es un estudio retrospectivo en un periodo prolongado, el número de casos es escaso y, como se desprende del reporte, no se logró identificar un perfil de paciente en riesgo de una complicación que no es bien comprendida; esta revisión solo pudo caracterizarla con mayor detalle. Con el propósito de avanzar en la comprensión de esta entidad, hemos definido un protocolo de estudio prospectivo de los pacientes que incorpora algunas mediciones de la relación neutrófilos/linfocitos, magnesemia y PCR pre y posoperatorias seriadas, descartar la presencia del Clostridium difficile y el uso precoz del octeótrido subcutáneo 18 en el manejo de esta complicación.…”

Provision of dietary advice for people with an ileostomy: a survey in the UK and Ireland

“…Appropriate dietary advice is particularly important for people with an ileostomy due to the nutritional risks associated with the loss of colon and changes in small intestine length and/or physiology, in conjunction with potential nutritional risks of dietary restriction for the purpose of managing consequences of their intestinal surgery [23,24]. In the weeks following ileostomy surgery, the remaining small intestine heals and adapts to the loss of the colon by increasing absorption of water and electrolytes [25]. Appropriate patient follow-up and support is needed, and dietary advice should be reviewed and adapted over time.…”

Postoperative Acute Kidney Injury in Colorectal Surgery

“…Meanwhile, high ileostomy output can be addressed in a step-up fashion involving dietary modification (refer to Crohn's & Colitis Foundation patient information), bulking agents (alter viscosity more than volume), antimotility agents (loperamide is supported by several randomized studies and has a favorable side effect profile), antisecretory agents, and ileostomy takedown. 8 Ideally, PO-AKI should be avoided as there are no pharmacologic therapies or association with poor outcomes. Ileostomy care pathways, in coordination with enterostomal therapists and nutritionists, are recommended and can reduce dehydration-related readmissions, but their utility in preventing AKI or preserving renal function is less studied.…”

“…More than 100,000 intestinal stomas are formed annually in the United States, approximately 40,000 of which are ileostomies. 8 Compared to those who do not, patients with ileostomies have higher rates of PO-AKI and incident CKD. 5 This is likely secondary to 15% to 20% experiencing PO-AKI and high rates of recurrent AKI after discharge.…”