A retrospective case series describing the outcomes of 7 early reversals of temporary ileostomies at a teaching hospital in Ndola, Zambia

  • Seke M.E. Kazuma
  • Bright Chirengendure
  • Patrick Musonda
  • Joseph Musowoya
  • Felix Chibwe
  • Mbangu Mumbwe
  • Muleya Inambao
Keywords: ileostomy, early ileostomy closure, early ileostomy reversal, quality of life, surgical wound infection, morbidity, intestinal perforation, typhoid, peritonitis, Zambia

Abstract

Temporary ileostomy, though a simple surgical procedure, is associated with high morbidity arising from a complicated clinical course that affects the quality of life and body image of the patient. Ileostomies are offered to moribund patients with delayed presentation, fulminant enteritis, and long-standing peritonitis due to ileal perforation with severe peritoneal contamination. Ileostomies enhance intestinal decompression with improved healing, early resolution of ileus, and early initiation of enteral feeding. However, ileostomy reversal to restore intestinal continuity is a major surgical procedure associated with high morbidity and mortality. The optimal timing of temporary ileostomy reversal is controversial following emergency surgery. We report on 7 cases of delayed presentation of peritonitis due to ileal perforation. The patients were initially treated with double-barrelled end ileostomies, and they underwent ileostomy closure at Ndola Teaching Hospital, Zambia, within 14 days of the respective index admissions, with good outcomes. For 6 of the patients, the indication for ileostomy reversal was dehydration resulting in renal dysfunction, and psychosocial disturbances were evident in all 7 patients. Five of the patients developed skin excoriation. Two patients developed surgical site infections after ileostomy closure. The mean duration of hospitalization was 22 days.

 

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Published
2021-01-08
Section
Case Series