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Ileostomy malfunction — Clinical Guidelines

Overview

Ileostomy malfunction refers to functional issues arising from an ileostomy, including obstructions, leaks, and other complications that can affect patient outcomes and quality of life. 8 17

Diagnosis

Clinical Presentation: Abdominal pain, distension, changes in stoma output (e.g., increased frequency, volume, or odor), and signs of dehydration or malnutrition. 8 17

Physical Examination: Inspection of the stoma for signs of irritation, prolapse, or leakage; palpation for intra-abdominal masses or tenderness. 8 17

Stoma Output Analysis: Monitoring output characteristics to identify abnormalities indicative of malfunction. 8

Imaging: Abdominal X-rays or CT scans may be necessary to assess for obstruction or other structural issues. 17

Management

Initial Management: Assess and stabilize the patient, addressing fluid and electrolyte imbalances, and managing any acute complications like infections. 8 17

Stoma Care: Ensure proper stoma care, including regular cleaning and use of appropriate appliances (e.g., convex appliances for flush ileostomies). 8 14

Endoscopic Evaluation: Consider endoscopy to identify and manage internal issues such as strictures or adhesions. 17

Surgical Intervention: For persistent obstructions or severe complications, surgical revision or repair may be required. 17

Special Populations

Obesity: Higher incidence of complications; meticulous surgical technique and close monitoring are crucial. 17

Chronic Ulcerative Colitis: Increased risk of complications; tailored management strategies are necessary. 17

Emergency Ileostomies: Higher complication rates; meticulous postoperative care and early intervention are essential. 17

Key Recommendations

Regular Monitoring and Stoma Care: Implement rigorous stoma care routines to prevent and promptly address malfunctions. (Evidence: Expert opinion 8)

Early Intervention for Complications: Initiate early endoscopic or surgical interventions for identified obstructions or severe issues to prevent further complications. (Evidence: Moderate 17)

Tailored Management for High-Risk Patients: Develop individualized care plans for patients with comorbidities like obesity or chronic ulcerative colitis to mitigate increased complication risks. (Evidence: Expert opinion 17)

References

1 Li J, Zhang Y, Gu W, Wang T, Zhou Y. Diagnosis, management, and prevention of malfunctions in anesthesia machines. Technology and health care : official journal of the European Society for Engineering and Medicine 2023. link 2 Ikeda T, Orii R, Iwakiri M, Uchida K, Yamada Y. Unexpected deposits in the anesthetic circuit: a possible cause of PEEP/Pmax valve malfunction. Journal of clinical monitoring and computing 2021. link 3 Lapostolle F, Laghmari N, Reuter PG, Akodad H, Adnet F. [When the patient calls the SAMU because his pacemaker is making "beep-beep". Study on physicians' knowledge on pacemaker sound alarm]. Annales de cardiologie et d'angeiologie 2018. link 4 Fissekis S, Hodgson DS, Bello NM. Effect of cleaning status on accuracy and precision of oxygen flowmeters of various ages. Veterinary anaesthesia and analgesia 2017. link 5 Ahmad-Sabry MHI. Disease model: a simplified approach for analysis and management of human error: a quality improvement study. Medicine 2015. link 6 Bourgain JL, Coisel Y, Kern D, Nouette-Gaulain K, Panczer M. What are the main "machine dysfunctions" to know?. Annales francaises d'anesthesie et de reanimation 2014. link 7 . User experience network. Medical gas quick-connects may spontaneously detach. Health devices 2010. link 8 McKenzie F, Ingram V. Dansac Invent convex in the management of flush ileostomy. British journal of nursing (Mark Allen Publishing) 2001. link 9 Chung DC, Ho AM, Tay BA. "Apnea-volume" warning during normal ventilation of the lungs: an unusual leak in the Narkomed 4 Anesthesia System. Journal of clinical anesthesia 2001. link00241-5) 10 Williams D. From leaking devices to smart permeability: the technology of diffusion and other transport mechanisms. Medical device technology 1998. link 11 Somprakit P, Soontranan P. Low pressure leakage in anaesthetic machines. Evaluation by positive and negative pressure tests. Anaesthesia 1996. link 12 Erickson SL, Sweesy MW, Forney RC, Calabria DA. A verified report of spurious programming: a case study. Pacing and clinical electrophysiology : PACE 1995. link 13 Lycke KG, Göthlin JH, Jensen JK, Philipson BM, Kock NG. Radiology of the continent ileostomy reservoir: I. Method of examination and normal findings. Abdominal imaging 1994. link 14 Thompson JS, Williams SM. Technique for revision of continent ileostomy. Diseases of the colon and rectum 1992. link 15 Cudmore J, Keogh J. Another Selectatec switch malfunction. Anaesthesia 1990. link 16 Hauser RG, Edwards LM, Giuffre VW. Limitations of pacemaker system analyzers for the evaluation of implantable pulse generators. Pacing and clinical electrophysiology : PACE 1981. link 17 Babcock G, Bivins BA, Sachatello CR. Technical complications of ileostomy. Southern medical journal 1980. link

Ileostomy malfunction