Sodium and potassium excretion in patients with ileostomies.

The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients were investigated at home because most studies of sodium and water balance in patients with ileostomies have been done in hospital wards, which may not reflect actual conditions. Mean (SD) ileostomy output was 565 (152) ml in patients with ulcerative colitis and 1,267 (540) ml in patients with Crohn's disease. The intrapatient variation was limited, whereas the interpatient variation was significant and correlated with the length of small bowel resected. The sodium concentration in the ileostomy discharge was 110 (9.2) mmol/l and did not change consistently with ileostomy volume. The potassium concentration was 10 (2.1) mmol/l. There was a significant inverse correlation between daily ileostomy sodium output and urinary sodium concentration (r = -0.44, p less than 0.01), and a significant correlation between the daily output of sodium in ileostomy contents and the sodium:potassium ratio in urine. We conclude that patients with ileostomies are at risk of sodium and water depletion, particularly those who have had small bowel resections. Increased sodium output from the ileostomy is associated with a reduction in the sodium:potassium ratio in the urine. To screen patients at risk, an estimate of the sodium balance can be made by measuring sodium and potassium concentrations in a single specimen of urine.

Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy.

Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. All women were examined by an independent gynaecologist and abnormalities of the internal genital tract were registered. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% (6/71) before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion with- out any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within 5 years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 21 delivered by caesarean incision. In conclusion, conventional proctocolectomy in women will result in distressing vaginal discharge, and dyspareunia in a considerable proportion of the patients. The operation also seems to decrease their chances of becoming pregnant.

Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease.

Ileostomy complications in 203 patients operated on with proctocolectomy and ileostomy for ulcerative colitis and Crohn's disease were investigated prospectively. The patients were examined at regular intervals by interview and thorough examination of the stoma. Stomal dysfunction was carefully assessed and patients presenting with surgical complications were admitted for reconstruction. The crude rate of ileostomy complications necessitating reconstruction was 34% and significantly higher in patients with Crohn's disease compared with patients with ulcerative colitis. The cumulative rate of surgical revision after 8 years was 75% in the former group and 44% in the latter. Ileostomy stenosis and sliding recession were the two most common indications for reconstruction. Eighty-three per cent of the revisions were performed as local procedures, making a formal laparotomy unnecessary. Causative factors such as surgical technique, length of concomittant ileal resection and postoperative weight gain were analysed for possible influence on the rate of reconstruction, but no significant association was identified.

Sexual adjustment in ileostomy patients before and after conversion to continent ileostomy.

Questionnaires were sent to 48 ileostomy patients to evaluate the effects on sexual life of an ileostomate before and after conversion to a continent ileostomy. Forty-two patients (88 per cent) returned their questionnaires. Ninety-eight per cent of the patients had sometimes felt embarrassed, uncertain or inhibited by the conventional stoma, whereas only 24 per cent had these reactions after conversion to a continent ileostomy. About 80 per cent of the patients thought that the conventional ileostomy disturbed their sexual life because of the risk of leakage, odor, noise or such inhibitory influence to the continent ileostomy. Four men (31 per cent) and 15 women (52 per cent) reported that their sexual activity was reduced or absent when they had their conventional ileostomy. After conversion to a continent ileostomy all but one man and one woman considered their sexual activity to be normal. One-third of the patients claimed that the partner was embarrassed by the conventional ileostomy, but no partner admitted a negative reaction towards the continent ileostomy. Conversion to a continent ileostomy improved the quality of sexual life in about 85 per cent of both men and women.

Loop ileostomy--an attractive alternative to a temporary transverse colostomy.

Right-sided transverse colostomy and loop ileostomy when temporary used for protecting a new-constructed colorectal anastomosis were compared in two matched series of patients. The relative safety of the methods as expressed in complication rate on construction and subsequent closure and any difficulties associated with stoma care were assessed. The results indicate that a loop ileostomy, when properly constructed is well born even in elderly patients and is followed by a remarkably swift convalescence. Construction and closure appeared not to be associated with more difficulties or complications than transverse colostomy. As far as stoma care is concerned, transverse colostomy offered, if anything, more difficulties than the loop ileostomy. With modern appliances a loop ileostomy presents no more problems than a well-established conventional end ileostomy, and since a loop ileostomy is a more reliable defunctioning stoma than the transverse colostomy, it should probably be preferred when the primary purpose is to protect a colorectal anastomosis.