Management of a High Output Ileostomy - An Evidence Based Review of Current Clinical Practice

Abstract

Background: High output ileostomy is a commonly encountered condition in Medical and Surgical Gastroenterological practice. It is commonly seen after surgeries that involve defunctioning the large bowel, and thereby largely bypassing a substantial segment of the intestinal tract that is involved with water re-absorption. The acute morbidity associated with a high output stoma ranges from delayed discharge from hospital and acute kidney injury (AKI) requiring closely monitored fluid and electrolyte replacement to life-threatening renal impairment and electrolyte imbalances requiring Intensive Care admission. In addition, there is significant evidence suggesting progression of AKI to Chronic kidney disease (CKD), which can be a major contributor to long term morbidity and mortality. Our article reviews different validated management protocols in place in the various United Kingdom trusts for the same. Our aim is to provide readers with a clear, comprehensive and step-wise strategy to deal with acute kidney injury and high output stoma in patients with an ileostomy. Methods of review: A systematic search was conducted through PubMed, Embase and Google Scholar for relevant articles using the keywords Ileostomy, High Output Stoma, Management and Acute Kidney Injury. Abstracts were then filtered by authors based on the relevance to our review, which is primarily focused on high output stoma following the construction of an ileostomy in an acute setting. Conclusion: A systematic way of managing patients with high output stoma requires close liaising with nurses, dietitians and pharmacists as well as strict adherence to established protocols in conjunction with tight monitoring of renal, nutritional and biochemical parameters to improve outcomes. Wherever possible, reversing the stoma should be done to prevent morbidity associated with a high output stoma.