Ann Coloproctol.  2018 Apr;34(2):94-100. 10.3393/ac.2017.06.14.

Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis

• Kameyama H
• Hashimoto
• Shimada Y
• Yamada S
• Yagi R
• Tajima Y
• Okamura T
• Nakano M
• Miura K
• Nagahashi
• Sakata J
• Kobayashi
• Kosugi SI
• Wakai T

• KMID: 2411568
• DOI: http://doi.org/10.3393/ac.2017.06.14

Abstract

PURPOSE
Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC.
METHODS
The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters.
RESULTS
The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14-72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009-8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO.
CONCLUSION
The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.

Keyword

Ulcerative colitis; Ileostomy; Small bowel obstruction

MeSH Terms

Colitis, Ulcerative*
Female
Humans
Ileostomy*
Logistic Models
Male
Medical Records
Risk Factors
Tomography, X-Ray Computed
Ulcer*