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PubMedDate not supplied

Sexual adjustment in ileostomy patients before and after conversion to continent ileostomy.

Questionnaires were sent to 48 ileostomy patients to evaluate the effects on sexual life of an ileostomate before and after conversion to a continent ileostomy. Forty-two patients (88 per cent) returned their questionnaires. Ninety-eight per cent of the patients had sometimes felt embarrassed, uncertain or inhibited by the conventional stoma, whereas only 24 per cent had these reactions after conversion to a continent ileostomy. About 80 per cent of the patients thought that the conventional ileostomy disturbed their sexual life because of the risk of leakage, odor, noise or such inhibitory influence to the continent ileostomy. Four men (31 per cent) and 15 women (52 per cent) reported that their sexual activity was reduced or absent when they had their conventional ileostomy. After conversion to a continent ileostomy all but one man and one woman considered their sexual activity to be normal. One-third of the patients claimed that the partner was embarrassed by the conventional ileostomy, but no partner admitted a negative reaction towards the continent ileostomy. Conversion to a continent ileostomy improved the quality of sexual life in about 85 per cent of both men and women.

Adult↗
PubMed1984

[Pathophysiological assessment of continent ileostomy in patients with ulcerative colitis--with special reference to the internal pressure and capacity of ileostomy].

Eight patients subjected to surgery for ulcerative colitis were followed up 1-27 years. Of eight, 3 patients received Kock's continent ileostomy and 5 patients end ileostomy. The survey was performed mainly in terms of emptying frequency, the internal pressure and the capacity of the ileostomy. The patients with continent ileostomy empty their reservoirs one to four times a day, while the patients with end ileostomy change the ileostomy bags four to ten times a day. In patients with Kock's ileostomy, high pressure zone was observed at 3 to 6 cm proximal to the stoma corresponding to the site of the nipple valve. The pressure of the nipple valve showed higher than the internal pressure of the reservoir. When the internal pressure at the site of 10 cm proximal to the stoma was measured after end ileostomy, it increased proportionally to the amount of infused saline. Infusion of 50 ml of saline induced its evacuation from the stoma without causing any sensation of fullness to the patients. The patients with Kock's ileostomy announced sensation of fullness when 80% of the maximal capacity of the reservoir was filled with saline. This sensation of fullness made it easy for the patients to control emptying the reservoir. Therefore, we conclude that Kock's procedure should be more widely performed to ulcerative colitis when ileostomy is required.

Adolescent↗
PubMed1988

Quality of life in ileostomy patients before and after conversion to the continent ileostomy.

In a prospective study the quality of life was evaluated in 31 consecutive patients before and after conversion from a conventional to a continent ileostomy. Patient expectations, immediate emotional reactions after the operation and attitudes at the time of the interview were more positive towards the continent ileostomy than the conventional ileostomy. An improved working capacity was affirmed after conversion to the continent ileostomy. Leisure activities and the quality of sexual life were most positively influenced by the continent ileostomy, whereas established family and social relations were not considerably influenced by either type of ileostomy. In conclusion the continent ileostomy improves the quality of life in patients requesting conversion from a conventional ileostomy.

Adaptation, Psychological↗
PubMed1995

The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch.

A new method for allowing stool passage into the pelvic pouch before ileostomy closure to verify the defecation state and diminish stool frequency is reported herein. This was accomplished by fitting an ileostomy connector connecting the proximal and distal openings of the diverting loop stoma. The ileostomy connector was initially in place for 6 h a day, the length of time being gradually increased until it was able to be left in for 24 h a day over a 3-month period. The calculated daily frequency of stools decreased from 24 to 6 or 7 times, and the mean daily frequency immediately after ileostomy closure was 6.5 times. Physiological study also showed an improvement, with squeeze pressure increasing from 35 cmH2O to 116 cmH2O and the maximum tolerated volume increasing from 35 ml before, to 90 ml 3 months following the use of an ileostomy connector. Thus, we conclude that an ileostomy connector may be useful to predict postoperative functional outcome and its complications, and to diminish the frequency of defecation before ileostomy closure in patients with a covering loop stoma.

Adult↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1981

Loop ileostomy for protection of the newly constructed ileostomy reservoir.

Sixteen patients submitted to reservoir ileostomy were at the same time given a proximal loop ileostomy to defunction the reservoir for 2-3 months. All made smooth recoveries in the immediate postoperative period both before and after the closure of the loop ileostomy. During follow-up of at least 12 months the function of the reservoir ileostomy has been excellent except in one patient who developed dysfunction of the nipple valve requiring reoperation. On the basis of this experience, it is suggested that a temporary defunction loop ileostomy is a wise precaution in connection with reservoir ileostomy, which may lessen the incidence of complications and reduce the risks of later valve extrusion.

Adult↗
PubMed1992

Ileostomy output of gas and feces before and after conversion from conventional to reservoir ileostomy.

In 28 patients who had previously had a proctocolectomy for ulcerative colitis, the ileostomy output of feces was determined before and after conversion to continent reservoir ileostomy, as was the output of gas in 20 of the patients. The median output of feces/24 hours collected in the hospital was 576 g before and 692 g after conversion (P less than 0.05); when collected at home the corresponding figures were 734 g and 740 g, respectively. In the majority of patients, the change in fecal ileostomy output after the conversion was not considerable, while in a few patients there was a marked increase. The fecal output was 24 percent (P less than 0.01) and 11 percent (P less than 0.01) larger at home than in hospital before and after conversion, respectively. The proportion dry weight of ileostomy discharge decreased after conversion (P less than 0.01). The median gas volume in the ileostomy output/24 hours was 1,664 ml before and 1,450 ml after conversion. The gas constituted 58 percent of the output and is significant with respect to the required reservoir capacity. Recording the emptying volumes and frequency in patients with reservoir ileostomy showed that, in general, patients with large output expand their reservoir capacity instead of increasing their emptying frequency.

Adult↗
PubMed1987

The Kock continent ileostomy: influence of a defunctioning ileostomy and nipple valve stapling on early and late morbidity.

Early and late morbidity was studied in 45 consecutive patients submitted to the Kock continent ileostomy reservoir procedure protected by a temporary loop ileostomy. In 24 patients the nipple valve was made by simple intussusception of the ileal segment after stripping of its mesenteric peritoneum and fat, whereas in 21 patients the nipple valve was stapled in addition. The early complication rate was low with necrosis of the nipple valve occurring in 3 patients and a nipple valve fistula in 1. These complications were easily dealt with and revision was done subsequently on an elective basis. The overall revision rate for late nipple valve dysfunction, mainly caused by sliding of the nipple valve was 29%. The majority of these complications occurred within the first postoperative year. Stapling of the nipple valve did not significantly reduce the rate of sliding. The overall complication rate was significantly less compared with a historical series of 21 patients not provided with a loop ileostomy. A temporary defunctioning ileostomy may reduce early complications and their consequences. Whether it may also lessen the risk of later nipple valve sliding is, however, not clear from this study. The observation that sliding was as common in both unstapled and stapled patients could imply either that the loop ileostomy is beneficial in preventing this complication or that the stapling procedure is in this respect unimportant. Which step or steps among all the measures employed are important in increasing the success rate of this operation remains unclear. Randomised controlled studies are needed for a true evaluation of this issue.

Adult↗
PubMed1971

Abortion studies in patients with "intraabdominal ileostomy reservoirs" and in patients with conventional ileostomies.

Twenty patients with ileostomy were studied concerning the absorption of d-xylose, fat, l-phenylalanine, and vitamin B(12). Ten patients had a conventional ileostomy, whereas 10 others were provided with an intraabdominal intestinal ileostomy reservoir resulting in faecal continence. No remarkable differences in the absorption of d-xylose, fat, or l-phenylalanine were found between the two groups of ileostomy patients. Most of the absorption values were within normal or borderline ranges. In the reservoir group the Schilling test gave subnormal values in six out of 10 patients, whereas only one patient in the group with a conventional ileostomy had a subnormal value. The reason for this finding is briefly discussed.

Administration, Oral↗
PubMed1988

Total body water and total body potassium in ileostomy patients before and after conversion to the continent ileostomy.

Total body water (TBW) and total body potassium (TBK) were studied in 40 ileostomists before (with conventional ileostomy) and one year after conversion to a continent ileostomy. Each patient acted as his own control. Total body water was determined by using an isotope dilution technique and TBK by counting the gamma radiation from the naturally present nuclide 40K in a whole body counter. Measured values of TBW and TBK were compared intraindividually (conventional versus continent ileostomy) and also with 'normal values' obtained from the same laboratory and based on a multiple regression analysis of data from 476 healthy controls. There was no evidence of water or potassium depletion in ileostomy patients, neither before nor after construction of the continent ileostomy.

Adult↗
PubMed1986

Continent ileostomy with protective loop ileostomy: early experience.

A continent ileostomy for patients with ulcerative colitis or polyposis coli is one of the alternatives to a conventional ileostomy. Construction of the continent ileostomy is a complex operation that can be followed by multiple, serious, and rather intractable surgical complications. In a small series of ten patients, a temporary diversion loop ileostomy was used to promote uncomplicated healing. The lack of any immediate surgical postoperative complications supports our point of view that, at least in centers with little experience of continent ileostomy, a two-stage procedure is preferable to a one-stage procedure.

Adult↗
PubMed1986

Effect of azodisal sodium and sulphasalazine on ileostomy output of fluid and PGE2 and PGF2 alpha in subjects with a permanent ileostomy.

Azodisal sodium is a highly effective means of oral delivery of 5-amino-salicylic acid to the colonic mucosa. Administration of this drug to patients intolerant of sulphasalazine, however, occasionally results in liquid stools. In preliminary experiments, which comprised 10 healthy volunteers treated with colectomy for ulcerative colitis, ileostomy fluid output increased (p less than 0.001) during oral intake of azodisal sodium (1 g/day). In a double blind, placebo controlled crossover study, comprising eight similar volunteers, ileostomy fluid output increased (p less than 0.05) in a dose related manner during intake of azodisal sodium (1 g/day vs 2 g/day) compared with placebo or sulphasalazine (2 g/day). Concentrations of prostaglandin (PG)F2 alpha in free ileal water determined by equilibrium in vivo dialysis of ileostomy contents decreased (p less than 0.05) during intake of azodisal sodium (2 g/day), whereas concentrations of PGE2 and the output of PGE2, PGF2 alpha, and 'PGE2 + PGF2 alpha' remained unchanged. Thus increased formation of PGs is apparently not the cause of increased ileostomy fluid output associated with azodisalicylate intake.

Adult↗
PubMed2003

Ileocecal valve-preserving ileostomy after total proctocolectomy--a novel technique for ileostomy.

BACKGROUND: Although ileoanal anastomosis has become popular for ulcerative colitis, in an emergency situation patients must undergo ileostomy. AIM: A novel ileocecal valve-preserving ileostomy procedure was devised to reduce high output liquid loss. METHOD: After total colectomy, the ascending colon was clamped and the terminal ileum and ileocecal valve were isolated from the cecum by dissection. The ileum was then brought out through a conventional ileostomy opening in the abdominal wall. RESULTS: Two patients with ulcerative colitis underwent ileostomy in this fashion. The stool became solid within 1 week after the start of solid food and their body weight increased by more than 10% 1 year after surgery. CONCLUSION: This novel procedure may result in an improvement in the quality of life of patients who undergo total proctocolectomy.

Adult↗
PubMed1996

Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone.

PURPOSE: We report the indications, technique, and results of conversion of the ileoanal pouch to the Kock's pouch in five patients. The indication was functional disturbance that could not be corrected by operation. Aim of the conversion operation was re-establishment of fecal control and complete preservation of existing ileal surface. METHODS: The ileal pouch was used again, and in one case an augmentation was made. The continence valve was made three times from the afferent loop and in two cases from a higher ileal segment. RESULTS: Following conversion, function was excellent in three patients with ulcerative colitis and in one patient with familial adenomatous polyposis. One woman who underwent proctocolectomy for slow-transit constipation needed a Brooke ileostomy for continuous abdominal distention pain. CONCLUSION: We conclude that conversion to a continent ileostomy is a rewarding method of safely eliminating dysfunction of the ileoanal pouch that cannot be corrected by operation. Presumption is, however, that the surgeon is familiar with both methods and that the primary disease is suitable for pouch surgery.

Adenomatous Polyposis Coli↗
PubMed1976

A stomal appliance for provisional ileostomy in neonates of low weight at birth who require temporary ileostomy.

In the surgical treatment of infants of low weight at birth for various congenital or acquired intestinal defects, it occasionally becomes necessary to divert intestinal contents by temporary ileostomy. There are no commercially available stomal appliances that are suitable for patients of this size. A rapid and easy method of constructing such an appliance is presented. The appliance protects peristomal skin, reduces nursing skin care time, and provides an easy and efficient method of collecting and measuring stomal affluent.

Enterocolitis, Pseudomembranous↗