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01-03-2017 | Original Article

Clinical Characteristics of Stoma-Related Obstruction after Ileal Pouch–Anal Anastomosis for Ulcerative Colitis

Authors: Yoshiki Okita, Toshimitsu Araki, Satoru Kondo, Hiroyuki Fujikawa, Shigeyuki Yoshiyama, Junichiro Hiro, Mikihiro Inoue, Yuji Toiyama, Minako Kobayashi, Masaki Ohi, Yasuhiro Inoue, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki

Published in: Journal of Gastrointestinal Surgery | Issue 3/2017

Abstract

Aims

We defined small bowel obstruction occurring around the limbs of the ileostomy as stoma-related obstruction (SRO) and investigated the clinical characteristics and predictive factors of SRO.

Methods

From January 2002 to March 2016, 309 consecutive patients who underwent ileal pouch–anal anastomosis (IPAA) for ulcerative colitis were enrolled. Two-stage IPAA with diverting ileostomy was analyzed. We assessed the possible associations between SRO and clinical factors.

Results

A total of 205 patients met the inclusion criteria. Fifty-three (25.8%) patients with SRO before ileostomy closure were identified for review. All patients with SRO were at least transiently resolved by intubation though orifice of ileostomy (98.1%) or nasally (3.7%). In 18 (33.9%) patients, the ileostomy was taken down ahead of schedule and the small bowel obstruction improved in all cases. Multivariate analysis revealed that age at surgery <16 years old and body mass index <21 were significant predictive factors for SRO (P = 0.013 and 0.0012, respectively).

Conclusion

Younger age at surgery and low body mass index may be significant predictive factors for SRO after IPAA with diverting ileostomy in patients with ulcerative colitis.

Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995; 222: 120–127.CrossRefPubMedPubMedCentral

Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, Fazio VW, Tekkis PP. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg 2008; 143: 406–412.CrossRefPubMed

Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12: 958–964.CrossRefPubMed

Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J, Carr ND. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis 2003; 5: 49–52.

Hughes ES, McDermott FT, Masterton JP. Intestinal obstruction following operation for inflammatory disease of the bowel. Dis Colon Rectum 1979; 22: 469–471.CrossRefPubMed

Francois Y, Dozois RR, Kelly KA, Beart RW, Jr., Wolff BG, Pemberton JH, Ilstrup DM. Small intestinal obstruction complicating ileal pouch-anal anastomosis. Ann Surg 1989; 209: 46–50.CrossRefPubMedPubMedCentral

Marcello PW, Roberts PL, Schoetz DJ, Jr., Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum 1993; 36: 1105–1111.CrossRefPubMed

Anderson DN, Driver CP, Park KG, Davidson AI, Keenan RA. Loop ileostomy fixation: a simple technique to minimise the risk of stomal volvulus. Int J Colorectal Dis 1994; 9: 138–140.CrossRefPubMed

Keenan RA. Ileostomy “twist”—an avoidable complication. Dis Colon Rectum 1994; 37: 1176–1177.

10.

Welsch T, Buchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg 2007; 24: 149–156.CrossRefPubMed

11.

Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 1955; 2: 1041–1048.CrossRefPubMedPubMedCentral

12.

Dolejs S, Kennedy G, Heise CP. Small bowel obstruction following restorative proctocolectomy: affected by a laparoscopic approach? J Surg Res 2011; 170: 202–208.CrossRefPubMedPubMedCentral

13.

Uchino M, Ikeuchi H, Bando T, Matsuoka H, Matsumoto T. Efficacy of a Cross Incision at the Rectal Muscle Fascia and Ileostomy Rotation for Prevention of Outlet Obstruction at the Ostomy Site in Restorative Proctocolectomy for Ulcerative Colitis. Nippon Daicho Komonbyo Gakkai Zasshi 2011; 64: 73–77.

14.

Klos CL, Safar B, Jamal N, Hunt SR, Wise PE, Birnbaum EH, Fleshman JW, Mutch MG, Dharmarajan S. Obesity increases risk for pouch-related complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg 2014; 18: 573–579.CrossRefPubMed

15.

Fujii T, Morita H, Sutoh T, Yajima R, Tsutsumi S, Asao T, Kuwano H. Outlet Obstruction of Temporary Loop Diverting Ileostomy. Hepatogastroenterology 2015; 62: 602–605.

Title: Clinical Characteristics of Stoma-Related Obstruction after Ileal Pouch–Anal Anastomosis for Ulcerative Colitis
Authors: Yoshiki Okita
Toshimitsu Araki
Satoru Kondo
Hiroyuki Fujikawa
Shigeyuki Yoshiyama
Junichiro Hiro
Mikihiro Inoue
Yuji Toiyama
Minako Kobayashi
Masaki Ohi
Yasuhiro Inoue
Keiichi Uchida
Yasuhiko Mohri
Masato Kusunoki
Publication date: 01-03-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3329-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical Characteristics of Stoma-Related Obstruction after Ileal Pouch–Anal Anastomosis for Ulcerative Colitis

Abstract

Aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusion

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