From the Guidelines
The recommended management for intestinal obstruction caused by an ileostomy begins with conservative measures, including nil by mouth, intravenous fluid resuscitation, electrolyte correction, nasogastric tube decompression, and gentle irrigation of the stoma with warm saline, as suggested by recent clinical guidelines 1. When managing intestinal obstruction caused by an ileostomy, it is crucial to prioritize measures that reduce the risk of complications such as bowel ischemia, perforation, and sepsis.
- Key considerations in the management of intestinal obstruction due to an ileostomy include:
- Initial assessment to determine the severity of the obstruction and the presence of any signs of strangulation, such as severe pain, fever, or peritoneal signs.
- Implementation of conservative measures for mild obstructions, which may include dietary adjustments, such as avoiding high-fiber foods and encouraging thorough chewing, as well as staying hydrated by drinking isotonic fluids 1.
- Monitoring for signs of dehydration, such as low urinary sodium, and managing electrolyte imbalances.
- The use of medications like loperamide to help thicken stoma output and reduce the risk of dehydration.
- Surgical intervention may be necessary if conservative management fails, and this can involve procedures such as manual reduction of a prolapsed stoma, revision of the stoma, or laparotomy with lysis of adhesions, depending on the underlying cause of the obstruction.
- Prevention strategies, including proper stoma creation and patient education on diet and hydration, are essential in reducing the risk of intestinal obstruction in patients with an ileostomy 1.
- Regular follow-up with an ostomy nurse specialist can also help in early recognition and management of complications, improving patient outcomes and quality of life.
From the Research
Management of Intestinal Obstruction Caused by Ileostomy
The management of intestinal obstruction caused by an ileostomy can be complex and may require surgical intervention. The following options are available:
- Surgical treatment: Required for the most severe cases of intestinal obstruction, as stated in the study 2.
- Ileostomy revision: May be necessary to address complications such as stoma retraction, prolapse, stenosis, or parastomal hernia, as reported in the study 3.
- End ileostomy construction: A novel technique that can reduce the incidence of stoma outlet obstruction after rectal resection and total colectomy, as described in the study 4.
- Trans-stomal tube decompression: May be required to manage stoma-related obstruction, as mentioned in the study 5.
- Early stoma closure: May be necessary in cases of stoma-related obstruction, as stated in the study 5.
Options Analysis
The provided options are:
- A-refasioning
- B-hot sponge
- C-Expectant management
- D-Closure of ileostomy Based on the available evidence, D-Closure of ileostomy may be a viable option for managing intestinal obstruction caused by an ileostomy, as it can address complications such as stoma outlet obstruction. However, the choice of management depends on the specific circumstances and should be guided by the results of the studies 3, 4, and 5.
Key Considerations
When managing intestinal obstruction caused by an ileostomy, it is essential to consider the following: