Is Barium Enema Prior to Ileostomy Closure Necessary
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Purpose: A barium enema is frequently performed to check for healing prior to ileostomy closure, but there have been reports that ileostomy closure without a contrast study is safe in selected patients. The aim of this study was to assess the necessity of a routine barium enema prior to ileostomy closure. Methods: Between January 1994 and June 2005, 51 patients with a temporary loop ileostomy who had a barium enema prior to ileostomy closure at Chonbuk National University Hospital were retrospectively reviewed. These patients were divided into 2 groups, the protective ileostomy group and the ileostomy-after-leakage group. To examine the necessity of a routine barium enema prior to ileostomy closure, we assessed whether the barium enema results changed management and whether there were pelvic sepsis and obstructive symptoms following ileostomy closure. Results: In the protective ileostomy group (n=39), the barium enema was performed after a mean of 59 days (range: 27151 days). There were no abnormal findings at the barium enema, no schedule changes, no pelvic sepsis, and no obstructive symptoms following ileostomy closure. In the ileostomy-after-leakage group (n=12), the barium enema was performed after a mean of 54 days (range: 3082 days). In 2 patients, with barium enemas at 33 days and 36 days, an anastomotic leakage was found, and ileostomy closure was delayed. Conclusions: In patients with a protective ileostomy, a barium enema prior to ileostomy closure is unnecessary, but in patients with an ileostomy after leakage, barium enema should be considered.Keywords:
Ileostomy
Barium enema
Enema
Barium sulfate
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Table: Enterocutaneous Fistula at Old Ileostomy SitePurpose: Small bowel obstruction (SBO) is a usual complication following major abdominal surgery, which frequently requires surgical intervention. Temporary ilestomy is commonly employed for fecal diversion, which requires a second surgery, albeit small, for closure. At the time of ileostomy takedown, instead of a local excision, would a full laparotomy beneficial in reducing the risk of recurrent bowel obstruction? Methods: Patients with SBO were identified from the institutional ileal pouch anal anastomosis (IPAA) database of 3176 cases during a 23-year period. Clinical details reviewed and analyzed included timing of ileostomy closure and incisions used. Results: 794 episodes of SBO from 571 patients were identified following IPAA. Surgical intervention was required in 229 episodes (29%). Seventy six patients were excluded because no ileostomy was utilized (49), or ileostomy not closed (3) or closed at another institution. For the remaining 495 patients, average ileostomy duration was 120 days. The study group numbered 140 patients who had 1st episode of SBO before ileostomy closure. Depending on the incision type at the ileostomy takedown, the study group was divided into three subgroups: A) peristomal incision at the regular time of ileostomy takedown (> 7 wks), 102 patients; B) laparotomy at the regular time of takedown, 15 patients; C) laparotomy before the regular time of takedown, 23 patients. SBO recurrence was lower in patients who underwent a laparotomy (23.7%) than those who had peristomal incision (30.4%). There were 130 patients (26.2%) who developed their 1st SBO within 60 days following ileostomy closure. Of these, 101 (77.7%) had only one episode of SBO. 80 of the 101 (80%) patients were managed medically without recurrence. Conclusion: The ileostomy take down presents a valuable opportunity for patients who already display signs of obstruction. Laparotomy with full exploration at this point can safely reduce the risk of future bowel obstruction. The majority of bowel obstruction cases occurring immediately following take down can be successfully managed medically without recurrence.Table: Small Bowel Obstruction Recurrence after Ileostomy Takedown
Ileostomy
Proctocolectomy
Pouch
Stoma (medicine)
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Journal Article Restorative proctocolectomy without temporary ileostomy Get access W G Everett, W G Everett Department of Surgery, Level 7. Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK Search for other works by this author on: Oxford Academic Google Scholar S G Pollard S G Pollard Department of Surgery, Level 7. Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK Correspondence to: Mr S. G. Pollard Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 77, Issue 6, June 1990, Pages 621–622, https://doi.org/10.1002/bjs.1800770608 Published: 06 December 2005 Article history Accepted: 10 December 1989 Published: 06 December 2005
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Ileostomy
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Barium enema
Closure (psychology)
Ileostomy
Barium sulfate
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平成23年4月から平成29年3月までのileostomy患者38例を検討した．造設理由は予防目的25例，縫合不全に対する治療目的12例，その他1例であった．High-output stomaは44.7％に認められ，Outlet obstructionは21％で認められた．Stoma閉鎖率は88.2％であった．Stoma閉鎖後合併症は，小腸閉塞2例，創感染3例，偽膜性腸炎3例で，縫合不全は認めず，すべて保存的に治癒した．Ileostomyはdiverting stomaとして有用である一方でhigh-output stomaやOutlet obstructionの克服が課題である．Outlet obstruction 8症例中2例は発症時点でhigh outputを呈しており，従来の定義の矛盾が示唆され，outlet obstructionの病態理解の参考になると考えられた．
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Ileostomy
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Journal Article Dehiscence of the lateral space following its closure in colostomy and ileostomy Get access B P Bliss B P Bliss Registrar to the Professorial Surgical Unit Charing Cross Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 50, Issue 225, July 1963, Pages 730–731, https://doi.org/10.1002/bjs.18005022509 Published: 06 December 2005
BLISS
Closure (psychology)
Ileostomy
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