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High debit ostomies

High Debit Ostomies

  Normal stomas have a debit that varies between 500-1,000 ml per day due to ileostomies. The limit from which a stoma is considered to be producing a high debit is not clearly defined.

  Baker and collaborators, in a study carried out on ileostomies defined high-debit ostomies (OAD) as those cases in which 2,000ml were exceeded in more than 48 h. Other studies define OAD as debits greater than 1,000 ml – 1,200 ml maintained for 3-5 days.

  It is important to bear in mind that after the surgery a high self-limited debit occurs in a short period of time.

  In a meta-analysis published on the complications of stomata comparing colostomies versus ileostomies, it was found that only high debit presented significant differences, being more common in ileostomies.

 

Factors Triggering High Debit:

 

  The appearance of OAD is usually associated with triggers of different etiology:

  • Short bowel syndrome (SIC)
  • Infections: especially enteritis and abdominal sepsis.
  • Outbreak of inflammatory bowel disease.
  • Drugs: The sudden suppression of drugs such as corticosteroids or opiates, as well as the prescription of medicines with prokinetic effect (metoclopramide, laxatives, erythromycin) may increase the stoma output. It has been seen that metformin also produces increased stoma debit.
  • Partial or intermittent obstruction: After the resolution of the obstructions there are also large debit increases.

 

  The primary management of high-debit ostomy is the identification of the cause and its treatment. The detection of this cause is not easy and in the majority of the studies a small percentage is identified 50%.

  In a published study that includes the factors that affect the development of OAD, age, the presence of cancer and the application of neoadjuvant chemotherapy or radiotherapy as statistically significant variables stand out.

 

Implications for Developing High Debit:

 

  • Caloric malnutrition and weight loss: Malabsorption of nutrients and diarrhea cause gradual body mass losses, even though the patient receives a high-calorie diet. The presence or absence of colon is important in the treatment of these patients because it plays an important role in the rescue of non-absorbed carbohydrates since colonic bacteria degrade them to short-chain fatty acids that are absorbed by the colonocytes and can contribute this way up to 500kCal / day.
  • Vitamin B12 deficiency: Its absorption is limited to the ileum. This malabsorption depends on the length of the resected ileum. A resection of more than 60cm will lead to a demonstrable deficit of B12, which may cause pernicious or megaloblastic anemia in the patients.
  • Malabsorption of bile salts: The resection of more than 100 cm leads to severe malabsorption of bile salts that, in case of overcoming hepatic synthesis, may lead to a progressive decrease in the bile acid reserve and insufficient micellar solubilization of fats and liposoluble vitamins . In addition, both bile salts and fatty acids increase diarrhea.
  • Among others.

 

References:

Baker, M.; Williams, R.; Nightgale, J. (2011). Causes and management of a high-output stoma. Colorectal disease, 13:191-7.

Villafranca, J. y cols (2014). Ostomías de alto débito: Detección y abordaje.  Nutr Hosp. 30(6):1391-1396.

Tilney,  H.; Sains, P.; Lovegrove, R.; Reese, G.; Heriot, A; Tekkis, P. (2007). Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg, 31:1142-51.

Leonardo Tortolero
3 April, 2019

Written by

Dr. Tortolero is a surgeon specializing in Clinical Angiology (ASCARDIO). Fellow in comprehensive and interventional ultrasonography (UNEFM) and biomedical researcher. Member of the Venezuelan Association for the Advancement of Science, Venezuelan Society of General Medicine,...read more:

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