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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2011 April;24(2):85-7
Ileostomy closure: rare causes of complications
Sofia M., Barbagallo F., Gagliardo S., Chisari A., Sparatore F., La Greca G.
Department of Surgical Sciences, Organ Transplantations and Advanced Technologies, Department of Emergency Surgery University of Catania, Cannizzaro Hospital, Catania, Italy
The most frequent complication after ileostomy closure is small bowel occlusion, caused by adhesions, stricture or rarely by the stenosis of the efferent limb of ileostomy. We report two different cases of stenosis of the efferent limb of ileostomy. The first patient was submitted to a ileostomy after a small bowel resection for intestinal ischemia. The second patient had a ileostomy during a left emicolectomy performed in emergency, and the ileostomy was closed after ten months. The pathophysiology of the stenoses were analyzed in both the cases on the suggestion of the scarce literature. Late chronic effects of bowel ischemia, prolonged non function, delayed closure, previous chemotherapy and construction of the ileostomy in emergency can be factors producing bowel stenosis. The stenosis of the efferent limb of ileostomy is an infrequent event that can bring to severe bowel obstruction after closure of the ileostomy. Our cases underlines the importance of preoperative work-up to confirm viability of the distal bowel based on the accurate history of each patient. Timing, incision and technique of closure have to be carefully evaluated and tailored according to patient conditions to minimize the complications.