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