Examining The Frequency Of Ileostomy Complications Biology Essay


Place Duration: This study was conducted at surgical unit-I II Chandka Medical College Hospital, Larkana from August 2004 to February 2008.

Subjects Methods: Total 180 patients of ileostomies performed for various pathologies including enteric perforation, intestinal obstruction, abdominal tuberculosis and abdominal trauma were evaluated. The data collected by specially designed proforma for each patient. Preoperative preparation, investigations operative findings and post operative complications of ileostomy were documented.

Result: A total of 180 patients were evaluated. Age ranged between 12-65 years. Mean age was 29 years with + 13.31 sd. Male to female ratio was 1:1.22.

93 (51.6%) patients were of enteric perforation followed by 49 (27.2%) of intestinal obstruction, 20 (11.1%) of abdominal tuberculosis and 18(10%) of abdominal trauma. 72 (40%) patients developed variable complications; of which 38(21.1%) developed skin excoriation, 12(6.6%) retraction, 8 (4.4%) stenosis, 8(4.4%) stomal prolapse, 3 (1.6%) peristomal sepsis, 2 (1.1%) ischemia and bleeding 1(0.5%) . Mortality rate was zero.

Conclusion: It is concluded that ileostomy is a life saving procedure with little morbidity in various abdominal pathologies. Complications of ileostomy are common but most of them are manageable conservatively.

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Key words: Ileostomy, complications, stoma


The word "Stoma" comes from the greek word meaning mouth or opening1.

Ileostomy is surgically created opening in the small bowel (ileum) on to the anterior abdominal wall to divert intestinal contents. Those consisting of a single intestinal lumen are termed end ileostomy, those giving access to an afferent and efferent limb may be loop or double barrelled ileostomy. It may be temporary or permanent depending on their role2.

An ileostomy was first advocated in ulcerative collitis in 1912 (Brown 1913) but was not widely used until brooke demonstrated his everted ileostomy in 1952 3.

The ileostomy is created by bringing the terminal small bowel through a trephine incision preferably through the rectus muscle and then creating an everted spout of 2-3cm in length4.

Defunctioning loop ileostmies are used commonly to protect low colorectal anatomosis and there by reducing the serious complications of leakage .5

Ileostomy no doubt causes physical emotional trauma to the patient on one hand but it is a life saving procedure on the other hand. 6

Complications associated with stoma are frequent. The impact of these complications range from simple inconvenience to life threatening.7

Reported rates of stomal complications vary widely in the literature. Complication rates specific to loop ileostomies can be significant, ranging from 5.7% to 41%. 8

The aim of this study was to evaluate the frequency of complications of ileostomy; because ileostomy plays a key role in elective and emergency surgery.


Study Design: Descriptive Study

Place Duration: This study was conducted at surgical unit-I II Chandka Medical College Hospital, Larkana from August 2004 to February 2008.

Inclusion Criteria: All the patients in whom ileostomy was made due to excessive contamination or gangrenous loop were included in the study.

Exclusion Criteria: patients in which primary repair of perforation or resection anastomosis done were excluded from the study.

Data Collection: Total 180 patients of ileostomies operated for various pathologies were evaluated. All the patients were admitted through causality and were evaluated by detailed history, thorough clinical examination, laboratory investigations including complete blood count and ESR, blood urea, creatinine, serum electrolytes, blood sugar, widal test, typhidot, ultrasound abdomen, x-ray chest P/A view and plain x-ray abdomen erect and supine including both domes of diaphgram were also done.

The clinical assessment, operative findings as well as post operative complications were recorded. Initially all patients were resuscitated by administering intravenous fluids with electrolytes replacement. Antibiotics were given preoperatively and continued postoperatively. All patients were operated in emergency under general anesthesia. The specific surgical complications recorded were skin excoriation, retraction, stenosis, prolapse , peristomal sepsis, ischemia, bleeding and parastomal hernia were studied. Patients were followed for any complication for 6 to 8 weeks after ileostomy. The anesthetic, biochemical complications and complications related to laparotomy wounds were excluded.


A total of 180 patients of various pathologies who underwent Ileostomy during last three half years were included in this study. Out of these 93 (51.6%) were of enteric perforation followed by intestinal obstruction due to various causes 49 (27.2%), abdominal tuberculosis 20 (11.1%), penetrating and blunt abdominal trauma 18 (10%). (Table1).

Male to female ratio was 1:1.22 (No: 99 F and 81 M) age ranged from 12 to 65 years. The mean age was 29 years.

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The operations were performed under general anesthesia. All patients underwent laparotomy through midline incision and temporary loop ileostomy or double barrelled ileostomies were made in all cases, excluding those where primary repair of intestine were made.

One hundred eight - patients recovered without complications while 72(40%) patients developed various complications (Table:02) 38 (21.1%) patients developed skin excoriation followed by 12 (6.6%) ileostomy retraction, stenosis 8 (4.4%) stoma prolapse 8 (4.4%), ischemia 2 (1.1%), peristomal sepsis 3 (1.6%) and bleeding 1 (0.5%). No case of parastomal hernia was reported. Mortality rate was zero.

Table-1 Indications (n=180)

Abdominal Pathologies

Number of Patients (n=180)

Percentage (%)

Enteric Perforation


51.6 %

Intestinal obstruction


27.2 %

Abdominal Tuberculosis


11.1 %

Abdominal Trauma


10 %

Table-2 Complications (n=180)


Number of Patients (n=180)

Percentage (%)

Skin excoriation


21.1 %



6.6 %



4.4 %



4.4 %

Peristomal sepsis


1.6 %



1.1 %



0.5 %


Patients under going stoma formation are at risk of developing a wide range of complications following surgery 9. These may range from a minor inconvenience to a surgical emergency.

Robertson et al10 reported stoma related complications rate between 10 and 70% which may be because of varying lengths of follow up. In their study 408 patients under went ileostomy and colostomy. The percentage of patients who developed stenosis (1-2%) retraction (8-22%) and prolapse (1-3%).

The complications rate for skin excoriation, leakage, soiling or night time emptying were higher amongst the ileostomy patients.

Scarpa M et al11 in their study of 24 ileostomies in the treatment of severe constipation, surgical complications occurred in 11(46%) retraction in 6 (25%), peristomal sepsis in 3 (12.5%) and parastomal hernia in 2 (8.1%).

Duchesne CJ et al12 reported 25% ileostomy complications included prolapse in 9 (22%) necrosis in 9 (22%) stenosis in 7 (17%) irritation in 7(17%) infection in 6 (15%) bleeding in 2 (22%) and retraction in 2 (5%).

Safirullah et al13 evaluated major complications as skin excoriation (12%) oedema of spout (8%) prolapse (6%) and retraction (4%).

Park JJ14 noticed complications rate of 34%. The most common complications were skin irritation 12%, Prolapse 2 % and stenosis 2%.

Makela JT15 Niskasaari M reported parastomal hernia in 18 cases out of 163 stoma patients. In our study no case of parastomal hernia was observed.

Tajammul Hussain et al16 reported common complications as peristomal skin excoriation and ileostomy retraction.

Thalheimer A et al17 reported sixteen out of the 120 patients (13.3%) suffered stoma-related complications, requiring early ileostomy closure in three.

Shaukat Ali et al18 in their study death occurred in 3 (10%) patients who underwent ileostomy. In our study no death reported.

Akram Rajput et al19 reported skin excoriation was the most common complication, while poor siting, transient oedema, retraction high output were other less common complications.

MM Rathnayake et al20 in their study complications of loop ileostomy were retraction 1(0.7%), parastomal hernia 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), paraileostomy abscess 4 (3%) severe skin excoriation 9 (6%).

In this study 72 (40%) of our patients developed various major and minor complications of ileostomy. Most of these complications were treated conservatively but 13 cases (18%) required revisional surgery. (05 cases of ileostomy retraction, 05 cases of ileostomy stenosis and 03 cases of ileostomy prolapse). The percentage of revisional surgery reported by DA Harris et al is 36%, which is quite higher than our study.21


Conclusion: It is concluded that ileostomy is a life saving procedure with little morbidity in various abdominal pathologies. Complications of ileostomy are common but most of them are manageable conservatively.