Present status of the continent ileostomy: ileal reservoir with ileostomy rather than ileostomy alone.
Explore the source record for details and available documents.
Catheterization↗
SEARCH · PubMed Health
Results for “Ileostomy”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
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↗
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↗
Present status of the continent ileostomy: why the continent ileostomy?
Explore the source record for details and available documents.
Fecal Incontinence↗
Present status of the continent ileostomy: surgical revision of the malfunctioning ileostomy.
Explore the source record for details and available documents.
Abdominal Muscles↗
Ileostomy without external appliance: the continent ileostomy (Kock Pouch).
Explore the source record for details and available documents.
Adolescent↗
Randomized trial of loop ileostomy in restorative proctocolectomy.
A randomized controlled trial was performed to assess the role of loop ileostomy in totally stapled restorative proctocolectomy. Entry criteria included all patients who were not on corticosteroids in whom on-table testing revealed a watertight pouch with intact ileoanal anastomosis. Of 59 patients undergoing restorative proctocolectomy over 36 months, 45 were eligible and were randomized to loop ileostomy (n = 23) or no ileostomy (n = 22). The age and diagnosis of the groups were similar. There were no deaths; two ileoanal anastomotic leaks occurred, one in each group. Ileoanal stenosis occurred in five patients with and one without an ileostomy. The incidences of wound and pelvic sepsis, bowel obstruction and pouchitis were similar. Twelve patients (52 per cent) developed ileostomy-related complications. The median total hospital stay was 23 (range 13-75) days with ileostomy and 13 (range 7-119) days without (P < 0.001). This study indicates that there is a low risk of pelvic sepsis which is not increased by avoiding a protective ileostomy. Loop ileostomy was associated with a high incidence of complications.
Adolescent↗
The role of the defunctioning ileostomy in restorative proctocolectomy.
Restorative proctocolectomy is now the treatment of choice for most patients with ulcerative colitis and familial polyposis coli. Temporary defunctioning ileostomy has been advocated during the period of anastomotic healing to prevent pelvic sepsis. However, the ileostomy itself may be a source of significant complications. To examine ileostomy function we reviewed thirty five patients (mean age 34.5 +/- 1.95 years) who underwent restorative proctocolectomy. Thirty four patients had a defunctioning ileostomy established at the time of pouch anal anastomosis. Closure of the ileostomy has been carried out in 33 patients (mean closure time 3.1 +/- 0.29 months). One patient underwent early pouch excision. Thirteen of the 35 patients developed post-operative complications (37%), two directly related to the defunctioning ileostomy. Both occurred following closure of the stoma and required laparotomy. Serious complications associated with defunctioning ileostomy as demonstrated in this study are uncommon (8.5%). Given the potentially disastrous consequences of a pouch-anal anastomotic leak we feel that the relatively low morbidity associated with a defunctioning ileostomy justifies its continued routine usage in the operation of restorative proctocolectomy.
Adenomatous Polyposis Coli↗
Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity.
Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.
Bacteroides Infections↗
Stagnant loop syndrome in patients with continent ileostomy (intra-abdominal ileal reservoir).
Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of (1-14C) glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14CO2-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12, there was evidence of a stagnant loopsyndrome as oral lincomycin treatment resulted in increased absorption of B12 decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.
Adult↗
Antiperistaltic ileal segment in the prevention of ileostomy diarrhea.
Diarrhea, often profuse, accompanied by skin excoriation and nutritional and electrolyte depletion is a major complication of ileostomy. In an attempt to improve the course of these patients, an experimental study using dogs was undertaken to investigate an antiperistaltic ileal segment for the prevention of ileostomy diarrhea. Ileostomies were created in dogs. All the dogs with ileostomies died within nine days of weight loss and massive electrolyte and water depletion. A second group of animals underwent creation of an ileostomy simultaneously, with an antiperistaltic ileal segment placed 30.5 cm proximal to the ileostomy. These dogs maintained their weight and electrolyte and water balance. The stools in the group with the reversed ileal segment became semisolid to solid, compared to the watery diarrhea of dogs with ileostomies only.
Animals↗
Radiologic evaluation of the continent (Kock) ileostomy.
The continent ileostomy is a solution to the persistent difficulties of leakage, odor, and skin irritation produced by the conventional permanent ileostomy in patients who have had proctocolectomy. Patients with continent ileostomy do not use ileostomy appliances, have complete fecal continence, and need empty the ileal reservoir only 2 to 4 times a day. Radiographic examination is often of great value in assessing patients with continent ileostomy. Radiographic features of the normal continent ileostomy and complications of continent ileostomy are discussed with regard to plain film and contrast examinations.
Humans↗
Ileostomy in ulcerative colitis. Results in 149 patients.
The operative mortality among 144 patients treated with proctocolectomy and ileostomy for ulcerative colitis was 7.6%. Half the patients had fulminating colitis. Only 4 patients died during the follow-up period. Intestinal obstruction needing laparatomy occurred in 8.6%. Ileostomy revisions have been carried out in 13%, and significantly more often in females than males owing to a higher frequency of stoma retraction. Other ileostomy problems (leakage, skin soreness, excoriation) were experienced by nearly half the patients. These problems were episodic in the majority and could usually be remedied by instruction and new devices. Less than 7% used colostomy bags. In the remainder the changing interval appeared to be a measure of ileostomy success. The average length of the ileostomy spout was significantly longer in males without ileostomy problems (5.8 cm) than in males having leakage (3.7 cm). This difference was not apparent in females. Working and sexual impairment was rare. The success of an ileostomy depends on proper management, i.e., access to expert advice, instruction, training, follow-up, and adequate supplies of appliances. A stoma therapist on the staff is therefore extremely valuable.
Adult↗
Cause and management of high volume output salt-depleting ileostomy.
Ileostomy function was studied in 12 patients with an established ileostomy following proctocolectomy, in 6 of whom minimal amounts (less than 9 cm) and in 6 significant amounts (30-120 cm, mean 60 cm) of terminal ileum had been removed. Patients who had undergone significant ileal resection had daily faecal volumes considerably greater than those with minimal ileal resection (1202 +/- 284 ml versus 401 +/- 92 ml, P less than 0.001), and also greater daily outputs of sodium (146 +/- 53 mEq versus 43 +/- 12 mEq) and potassium (12.7 +/- 9.0 mEq versus 4.0 +/- 0.99 mEq). The percentage water content of the ileostomy fluid was greater in patients who had had the ileum resected (93.1 +/- 1.8% versus 89.8 +/- 2.5%). In addition, the sodium/potassium ratio in the urine in patients with a properly acting ileostomy after ileal resection was low. It is concluded that when recurrent inflammatory bowel disease, partial small bowel obstruction and intraperitoneal sepsis have been excluded there remains a number of patients whose high ileostomy output is due entirely to the amount of ileum resected. The management of patients with a high output ileostomy with codeine phosphate, Lomotil and oral administration of sodium chloride tablets is discussed.
Adult↗
Reduction of the effluent volume in high-output ileostomy patients by a somatostatin analogue, SMS 201-995.
Twelve ileostomy patients were given subcutaneous SMS 201-995 therapy (100 micrograms t.d.s. for 5 days) in a randomized placebo-controlled trial. All patients had ileostomies constructed 60 cm proximal to the terminal ileum (proximal ileostomy) following restorative proctocolectomy. SMS 201-995 reduced the daily ileostomy output from 997 +/- 52 g to 736 +/- 28 g, P < 0.05, along with a decrease in daily sodium and chloride excretion (sodium: 92.60 +/- 8.51 to 75.22 +/- 8.64 mEq, chloride: 143.46 +/- 8.54 to 113.60 +/- 15.84 mEq; both P < 0.05). There were no significant changes in the plasma levels of glucagon, C peptide, insulin, renin or aldosterone with SMS 201-995 therapy. Patients developed no severe side effects and reported easier management of the ileostomy and a reduction in thirst. Our results suggest a possible clinical role for SMS 201-995 in the management of proximal ileostomy.
Adolescent↗
Bile acid metabolism in ileostomy patients.
In ten ileostomy patients, a 14C-cholylglycine breath test was performed. The 14CO2 in the exhaled air and the 14C bile acid quantity and composition and fat content in the subsequent 24 h ileostomy effluent were determined and compared to the values in twenty healthy controls. The results show that in ileostomy patients only minor bile acid-deconjugation occurs in vivo. Deconjugation in the ileostomy bags was found to be mainly responsible for the absence of conjugated bile acids in many of the ileostomy effluent samples. Secondary bile acids were not present in these patients, as determined by TLC. The fecal fat and bile acid excretion was found to be in the normal range in ileostomy patients provided no concomitant ileum resection was present.
Bile Acids and Salts↗
[Continent ileostomy--indication and possibilities].
Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis but ileostomy appliances must be worn for the rest of their lives. The continent ileostomy, as devised by Kock, provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2-3 times a day by inserting a catheter through the valve. Our experience with 14 patients is reported. The continent ileostomy was in most cases constructed as a second procedure after proctocolectomy. Minor postoperative complications, such as abscess, fistula or partial luxation of the valve were easily corrected. One patient who underwent proctocolectomy and simultaneous construction of a continent ileostomy died in acute liver failure due to a severe preexisting cirrhosis. All the other patients are continent for feces and gas and do not need external appliances. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation with differs only insignificantly from that of normal persons.
Colitis, Ulcerative↗
The electrical potential difference across human ileostomy mucosa.
Some of the characteristics of the electrical potential across human ileostomy mucosa were assessed by measuring potential difference (P.D.) between ileostomy lumen and forearm skin in 28 subjects, 19 of whom had had ulcerative colitis and 9 Crohn's disease. The mean P.D. at 3 to 5 cm from the tip of the ileostomy was 17.2 mv +/- 0.6 (SEM) in the ulcerative colitis group and 16.5 mv +/- 1.1 in the Crohn's disease group. The P.D. was highest at the tips of ileostomies and decreased to about half the tip level at 10 to 15 cm deep to the tip. Even at this distance from the tip, P.D. was apparently higher than values reported in normal ileum. P.D. rose during the first few weeks after colectomy and reached a stable value at about 2 months. Plasma aldosterone levels were normal in 6 subjects but despite this, administration of an aldosterone antagonist, spironolactone, caused a fall in P.D. These apparently conflicting observations suggest that the raised P.D. was maintained, at least in part, as a response to normal levels of aldosterone and an increased sensitivity to aldosterone by ileal mucosa near to an ileostomy is postulated. A significant correlation between P.D. and salivary Na:K ratios also supports a relationship between P.D. and aldosterone levels. Another patient, with a jejunostomy, also had a high transmucosal P.D., suggesting that jejunal mucosa may respond in a similar manner. No evidence in favor of active K secretion was discovered, because K concentrations in ileostomy ejecta were no greater than those which could be predicted as a passive response to the P.D. except in some subjects during the 1st week after surgery.
Adolescent↗