Volume : VIII, Issue : XII, December - 2018

ILEOSTOMY: A LIFE SAVING PROCEDURE IN PERFORATION PERITONITIS IN MORIBUND PATIENTS

Dr. Ritika Garg, Dr. S C Sharma, Dr. Pallavi Ahluwalia

Abstract :

 INTRODUCTION –Ileostomy is an integral part of pelvic pouch surgeries when patients are unfit for definitive surgery in the presence of severe morbid conditions. Though a second operation is required to close the stoma with potential complications, it provides as an excellent option for temporary fecal diversion. The aim of this prospective study was to assess the safety and morbidity of creating an ileostomy in a series of high risk patients requiring temporary fecal diversion.METHODS– A prospective analysis was performed of all patients (n=56) needing ileostomy at TeerthankerMahaveer Hospital between January 2016 and December 2016. Only moribund patients requiring fecal diversion as an immediate lifesaving procedure were included in this study. All patients underwent an exploratory laparotomy. The conventional site for ileostomy was chosen. A tension free ileostomy was made using the terminal ileum. After closure of the laparotomy wound, the ileostomy was matured. Ileostomy bag was fitted at the conclusion of surgery. After suture removal, patients were discharged on oral diet and ileostomy care advice chart. On every fortnight follow up, following parameters were noted: anastomotic leak, retraction and skin excoriation.  All ileostomies were closed after a mean of 12 weeks.RESULTS – A total of 56 (n=56) ileostomies were created for temporary fecal diversion. The outcome (dependent) variables were rate of survival and postoperative complications. The independent variables were indication of surgery, duration between admission and surgery. Out of the 47 who survived, stoma closure was done in 44 and permanent stoma was left for 3. Survival rate was 83.9%. Indication for surgery in 64% cases was ileal perforation due to Koch’s abdomen. 33.9% patients were operated on day 2 of admission.CONCLUSION – In moribund patients requiring fecal diversion, ileostomy has proven to be a lifesaving procedure by saving the operating time with a limited infrastructure. Ileostomy in such patients also enables healing of the primary pathology, thus improving the overall survival.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

ILEOSTOMY: A LIFE SAVING PROCEDURE IN PERFORATION PERITONITIS IN MORIBUND PATIENTS , Dr. Ritika Garg, Dr. S C Sharma, Dr. Pallavi Ahluwalia , INDIAN JOURNAL OF APPLIED RESEARCH : Volume-8|Issue-12| December-2018

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