Renal impairment caused by temporary loop ileostomy

Beck-Kaltenbach, Nicole; Voigt, K.; Rumstadt, B.

doi:10.1007/s00384-010-1086-3

Cited by 59 publications

(59 citation statements)

References 23 publications

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“…Our findings of risk for dehydration and need for readmission and impact on renal function are consistent with prior reports from diverse reporting centers demonstrating that the challenges are universal and still need further study. [1,2] Perhaps the greatest opportunity for improvement is through interventions to manage the volume of ileostomy output. There are existing guidelines and algorithms regarding treatment of high output stomas.…”

Section: Discussionmentioning

confidence: 99%

“…[1] In addition, a prospective cohort study demonstrated that all patients with diverting ileostomies had a significant decrease in their glomerular filtration rates measured just prior to ileostomy closure compared to just after ileostomy creation. [2] Other ileostomy-related complications such as small bowel obstruction, stoma necrosis, prolapse, or retraction may not only result in readmissions but may also require reoperation. Other less clinically serious complications such as leakage from the stoma appliance and skin irritation may lead to a decrease in the patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…The presence of a stoma has been shown to consistently impair renal function, with clinical renal failure occurring in 20% of ileostomates 12 . Although readmissions are often multifactorial, dehydration represents a prevalent and potentially preventable target.…”

Section: Introductionmentioning

confidence: 99%

Readmission After Ileostomy Creation

et al. 2017

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Objective To evaluate causes and predictors of readmission after new ileostomy creation. Summary Background New ileostomates have been reported to have higher readmission rates compared to other surgical patients, but data on predictors are limited. Methods 1114 records at two associated hospitals were reviewed to identify adults undergoing their first ileostomy. Primary outcome was readmission within 60 days of surgery. Multiple logistic regression was used to identify independent predictors; receiver-operator characteristics (AUC) were used to evaluate age-stratified models in secondary analysis. Results 407 patients underwent new ileostomy. 58% had cancer, 31% IBD; 49% underwent LAR, 27% colectomy, 14% proctocolectomy. Median length-of-stay was 8 days. 39% returned to hospital; 28% were readmitted (n=113) at median of 12 days post-discharge. The most common causes of readmission were dehydration (42%), intra-peritoneal infections (33%), and extra-peritoneal infections (29%). Dehydration was associated with later, longer, and repeated readmission. Independent significant predictors of readmission were Clavien-Dindo complication grade 3–4 (OR 6.7), Charlson comorbidity index (OR 1.4 per point), and loop stoma (OR 2.2); longer length-of-stay (OR 0.5) and age 65 or older (OR 0.4) were protective. Cohort stratification above or below age 65 revealed that older patient readmissions were more predictable (AUC 0.84) with more preventable causes; younger patient readmissions were difficult to predict or prevent (AUC 0.65). Conclusions Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length-of-stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.

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“…Dehydration is responsible for renal failure in 50% of cases who develop renal failure, and high stomal output is the dehydration culprit in 44% of cases. 6 These ratios are highly significant in patients undergoing LT and receiving immunosuppressant agents, as renal function is either already impaired or on the verge of impairment in a sizable number of patients undergoing LT. Additionally, calcineurin inhibitors, including cyclosporine and tacrolimus, and prophylactic antibiotics used after transplant are toxic to the kidneys. Therefore, hydration is significant, even in uncomplicated transplant patients.…”

Section: Discussionmentioning

confidence: 99%

“…Given that the liver is highly susceptible to iatrogenic injury during transplant, circulatory dysfunction may occur upon portal clamping, and damage to the gastrointestinal mucosal barrier can be induced by high-dose steroids, posttransplant complications are observed most commonly in gastrointestinal organs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Gastrointestinal complications are common among patients who undergo solid-organ transplant and range from mild to moderate conditions, such as diarrhea or nausea, to more severe, life-threatening complications such as digestive bleeding and gut perforation. 5 Gastrointestinal perforation (GIP), which is potentially lethal, may occur at any point in the gastrointestinal tract, including the stomach, jejunum, ileum, and colon.…”

Section: Introductionmentioning

confidence: 99%

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Yılmaz

Akbulut²,

Yılmaz³

2017

Exp Clin Transplant

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Objectives: The aim of this study was to evaluate the incidence, possible risk factors, clinical presentation, and follow-up of patients with a gastrointestinal perforation after liver transplant. Perforations were located in the stomach (n = 1), jejunum (n = 3), ileum (n = 2), jejunum and ileum (n = 1), and colon (n = 2). Seven patients were managed by ostomies, and 2 by primary repair. Despite administration of proper antibiotic therapy and fluid resuscitation to all patients, 2 adults died of septic shock: 1 was caused by perforation and 1 was caused by anastomotic leakage after colostomy closure. Conclusions: A gastrointestinal perforation after a liver transplant is a rare but mortal complication.Considering delayed wound healing owing to immunosuppression, potentially larger ischemic tissue around the perforation site owing to cautery burns and the atypical clinical course that may be further masked by bile leakage, ostomy treatment should be preferred to primary repair. A loop ostomy for small and large bowel perforations after the liver transplant decreases mortality and morbidity.

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Renal impairment caused by temporary loop ileostomy

Abstract: Renal impairment is a well-known potential complication of loop ileostomy. To avoid this complication, close control and backup support is recommended in these patients.

Cited by 59 publications

References 23 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

Readmission After Ileostomy Creation

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