Unexplained systemic inflammatory response following ileostomy closure after ileal pouch-anal anastomosis: a deeper dive into a rare entity.
Int J Colorectal Dis
; 35(12): 2267-2271, 2020 Dec.
Article
em En
| MEDLINE
| ID: mdl-32778911
ABSTRACT
AIM:
The purpose of this study is to shed light on a rare complication following ileostomy closure after 3-stage IPAA for further study and discussion.METHODS:
Our department IPAA database was queried for all patients who underwent 3-stage IPAA creation from 2011 through 2018. Data was reviewed and analyzed using the SPSS application. Chi-square test and Fisher's exact test were used for categorical variables. t test or ANOVA was used for continuous variables. Significance was set at p < 0.05.RESULTS:
Three hundred seventy-eight charts were queried. Sixty-eight complications (18.0%) were identified after ileostomy closure. Thirty-seven were small bowel obstruction or partial small bowel obstruction (SBO or pSBO, 9.79%), 5 cases of leak from ileoileostomy anastomosis (7.4%), and 4 cases of leak from pouch (5.9%). There was no significant difference in time between restorative proctocolectomy with IPAA and loop ileostomy closure with cases where a complication occurred and where one did not (p = 0.28). Eight patients developed a SIRS response in the first 5 days after surgery without an identified intraabdominal source after extensive work-up. Of these patients, 87.5% also had negative re-explorations (both open and laparoscopic). None required re-diversion, and all recovered well.CONCLUSIONS:
While SBO remains the most common complication following ileostomy closure, a surprisingly large number of presents present with a SIRS response with no identifiable source. All of these patients recovered with supportive care, and none required further intervention or diversion. This is a poorly understood phenomenon which is unique to ileostomy closure after IPAA, and further study is required.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ileostomia
/
Colite Ulcerativa
/
Proctocolectomia Restauradora
/
Síndrome de Resposta Inflamatória Sistêmica
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
Int J Colorectal Dis
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Estados Unidos