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
Physical problems




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
Retraction
Ischaemia
Necrosis
Abscess
Fistula
Recurrent disease
Bleeding
Hernia
Pyoderma
Everting wrong end

Tension,obesity

Iatrogenic

Crohns,Cancer
 Varicies

negligence
Varices

Portal hypertension
 ALD
 Sclerosing cholangitis
 Liver mets
Treatment

Injection of sclerosant , phenol,alcohol.
 Needs repeat every 6weeks (Major 86)

Muco-cutaneous disconnection easy!
 20% recurrence in 30 months (Beck 88)
Hernia

10-40%
 20% require surgery (pain,obstruction etc)
 Repair by non absorbables 50% recurrence
rate.(Allen-Mersh (1988)
Mesh or Move?

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
ileostomy Flux

Normal 3-800ml/day
 >10cm resection significantly increases
flow
 Infection
 Radiation
 Crohns, cancer
 Obstruction 4-5l/day!
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
Metabolic

Chronic dehydration
 Anaemia ,low ferritin
 Low B12, Na, K
 Urate and calcium stones
 Gall stones (loss of bile salts)
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)
Stoma problems:
Retraction
Excoriation
Prolapse
Necrosis