Poor Outcome of a Defunctioning Stoma after Pouch Construction for Ulcerative Colitis

• Published in: Digestive surgery Vol. 17; no. 2; pp. 147 - 149
• Main Authors: Körsgen, Stephan, Keighley, Michael R.B.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2000
• Subjects: Colitis, Ulcerative - surgery; Humans; Ileostomy; Intestinal Fistula - etiology; Intestinal Obstruction - etiology; Original Paper; Postoperative Complications; Proctocolectomy, Restorative; Reoperation; Sepsis - etiology; Surgical Stomas; Treatment Failure; Defunctioning ileostomy; Restorative proctocolectomy; Complications; Ulcerative colitis
• ISSN: 0253-4886; 1421-9883; 1421-9983
• DOI: 10.1159/000018818

Background: Restorative proctocolectomy for ulcerative colitis can have complications necessitating a later defunctioning ileostomy with uncertain outcome. This analysis was undertaken to assess the outcome in patients needing a later defunctioning ileostomy after pouch construction in patients with ulcerative colitis. Method: The notes of our series of 154 patients who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis were reviewed and 28 patients identified who needed a later defunctioning ileostomy to deal with complications. Results: A later defunctioning ileostomy was necessary in 28 patients to deal with the following complications: sepsis in 11 patients (5 pouches failed), fistulas in 7 (5 pouches failed), poor function including ileoanal stenosis in 5 (all 5 failed), postoperative intraabdominal bleeding in 2 (both saved), pouchitis in 2 (1 excised) and small bowel obstruction in 1 (saved). 16 pouches were eventually excised or permanently defunctioned (59%). Conclusion: Complications necessitating a later defunctioning stoma after pouch construction carry a poor prognosis, especially when used for ileoanal stenosis and fistulae.