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Problems with ileostomies

Problems with ileostomies. Mr Paul S Rooney Colorectal surgeon Royal Liverpool Hospital. ileostomy. End (Brown 1930) Everted (Brooke 1952) Loop (Turnbull 1961). Generic Problems. Eczema Poor seal Sweating Hygiene Psychological (unnecessary changing) Physical and metabolic.

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Problems with ileostomies

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  1. Problems withileostomies Mr Paul S Rooney Colorectal surgeon Royal Liverpool Hospital

  2. ileostomy • End (Brown 1930) • Everted (Brooke 1952) • Loop (Turnbull 1961)

  3. Generic Problems • Eczema • Poor seal • Sweating • Hygiene • Psychological (unnecessary changing) • Physical and metabolic

  4. Retraction Ischaemia Necrosis Abscess Fistula Recurrent disease Bleeding Hernia Pyoderma Everting wrong end Tension,obesity Iatrogenic Crohns,Cancer Varicies negligence Physical problems

  5. Varices • Portal hypertension • ALD • Sclerosing cholangitis • Liver mets

  6. Treatment • Injection of sclerosant , phenol,alcohol. • Needs repeat every 6weeks (Major 86) • Muco-cutaneous disconnection easy! • 20% recurrence in 30 months (Beck 88)

  7. Hernia • 10-40% • 20% require surgery (pain,obstruction etc) • Repair by non absorbables 50% recurrence rate.(Allen-Mersh (1988)

  8. Heamatoma Infection Erosion Low recurrence rate<1%@5y (Bokey 2003) Laporotomy risk? Poorly sited likely to benefit Decision depends on patient factors and number of previous repairs Mesh or Move?

  9. ileostomy Flux • Normal 3-800ml/day • >10cm resection significantly increases flow • Infection • Radiation • Crohns, cancer • Obstruction 4-5l/day!

  10. Flux • Losses of >1L need replacing as saline • 1.5l need admitting • Can fatally induce Addisonian crisis • 100mg hydrocortisone qds (lifesaving) • Renal failure • Somatostatin PPI’s

  11. Metabolic • Chronic dehydration • Anaemia ,low ferritin • Low B12, Na, K • Urate and calcium stones • Gall stones (loss of bile salts)

  12. Closure • V easy or VV Hard • Try to avoid early closure wait 6 weeks at least • 50% complication rate inc death! • No one way of closure appears to be best (Hosie 1991)

  13. Stoma problems: Retraction Excoriation Prolapse Necrosis

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