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

6. Varices
Portal hypertension
ALD
Sclerosing cholangitis
Liver mets

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

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

9. Mesh or Move? Heamatoma Infection Erosion
Low recurrence (Bokey 2003)
Laporotomy risk?
Poorly sited likely to benefit
Decision depends on patient factors and number of previous repairs

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

11. 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

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

13. 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)

14. Stoma problems:
Retraction
Excoriation
Prolapse
Necrosis