The ?Blind Innsbruck Ostomy?, a cutaneous enterostomy for long-term histologic surveillance after small bowel transplantation

Abstract

Summary Intestinal transplantation has evolved into an established treatment for patients with intestinal failure. Although acute rejection episodes are reversible, late onset and chronic rejections remain major prognostic factors. We describe here our experience with endoscopic and histologic long‐term monitoring through a cutaneous enterostomy. Between 1989 and 2003, 24 intestinal transplants were performed. After revascularization and reconstruction of proximal intestinal continuity, a side‐to‐end ileo‐enterostomy was performed 20 cm from the stoma and the terminal allograft ileostomy left in the abdominal wall. Approximately after 2 months, in eight patients (nine transplants), the stoma was excluded from the gastrointestinal continuity, allowing ongoing endoscopy and histologic examination. Of 280 forceps biopsies, 64 (23%) were performed through the ‘blind ostomy’. Eleven acute allograft rejections were diagnosed between days 3 and 51, with two episodes in three cases. Through the ‘blind ostomy’, a late mild acute rejection was diagnosed in five instances, three to 37 months after transplantation. In all these patients, basal immunosuppression was intensified. Chronic rejection was seen in three cases 4–26 months after transplantation. In one of the three patients, chronic rejection was diagnosed from the excluded blind enterostomy. A long‐term cutaneous enterostomy, even if disconnected from the intestinal continuity, enables simple long‐term monitoring of small bowel allografts.

Intestinal transplantation: review of operative techniques

“…The ileostomy can be taken down after the adequate restoration of oral nutrition, the stabilization of the immunosuppression therapy, and in the absence of the need for frequent endoscopic surveillance. Other less frequently used methods that include the construction of a “Thiry‐Vella‐loop” (an excluded jejunal loop from the graft which is then exteriorized at both ends to gain access for biopsies from the graft; ), (modified) “Paul‐Mikulicz ileostomy” (a proximal side‐to‐side ileo‐ileal anastomosis with double‐barrel ileostomy to gain access to both the donor's and the recipient's ileum; ), and the “Blind Innsbruck Ostomy” (a side‐to‐end ileocolostomy 20 cm from the end of the graft, with the distal part of the graft brought out as a stoma for the purpose of graft monitoring, which is later excluded from GI continuity; ) have also been described.…”

Review of Various Techniques of Small Bowel Transplantation in Pigs

“…Generally, the ''Bishop-Koop ileostomy,'' in which the proximal part of the bowel is anastomosed end-to-side to the distal part which is then exteriorized as an ostomy, double barrel colostomy or loop ileostomy [1,43]. Alternative stoma techniques such as the ''Blind Innsbruck ostomy'' have also been described [44]. In this procedure a side-to-end ileocolostomy 20 cm from the end of the graft is surgically created.…”