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Unexplained systemic inflammatory response following ileostomy closure after ileal pouch-anal anastomosis: a deeper dive into a rare entity

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The purpose of this study is to shed light on a rare complication following ileostomy closure after 3-stage IPAA for further study and discussion.

Methods

Our department IPAA database was queried for all patients who underwent 3-stage IPAA creation from 2011 through 2018. Data was reviewed and analyzed using the SPSS application. Chi-square test and Fisher’s exact test were used for categorical variables. t test or ANOVA was used for continuous variables. Significance was set at p < 0.05.

Results

Three hundred seventy-eight charts were queried. Sixty-eight complications (18.0%) were identified after ileostomy closure. Thirty-seven were small bowel obstruction or partial small bowel obstruction (SBO or pSBO, 9.79%), 5 cases of leak from ileoileostomy anastomosis (7.4%), and 4 cases of leak from pouch (5.9%). There was no significant difference in time between restorative proctocolectomy with IPAA and loop ileostomy closure with cases where a complication occurred and where one did not (p = 0.28). Eight patients developed a SIRS response in the first 5 days after surgery without an identified intraabdominal source after extensive work-up. Of these patients, 87.5% also had negative re-explorations (both open and laparoscopic). None required re-diversion, and all recovered well.

Conclusions

While SBO remains the most common complication following ileostomy closure, a surprisingly large number of presents present with a SIRS response with no identifiable source. All of these patients recovered with supportive care, and none required further intervention or diversion. This is a poorly understood phenomenon which is unique to ileostomy closure after IPAA, and further study is required.

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Authors and Affiliations

  1. Department of Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10128, USA

    Stewart Whitney, Christopher LaChapelle, Michael Plietz, Justin George, Sergey Khaitov & Alexander Greenstein

Authors
  1. Stewart Whitney
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  2. Christopher LaChapelle
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  3. Michael Plietz
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  4. Justin George
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  5. Sergey Khaitov
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  6. Alexander Greenstein
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Contributions

Stewart Whitney, Christopher LaChapelle, Michael Plietz, Justin George, Sergei Khaitov, and Alexander Greenstein : substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be published

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Correspondence to Stewart Whitney.

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What does this paper add to the literature?

We believe this paper sheds light on a rare but difficult entity following ileostomy closure after IPAA. This entity of sepsis without a defined source often requires potentially unnecessary reoperations in an at-risk population.

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Whitney, S., LaChapelle, C., Plietz, M. et al. Unexplained systemic inflammatory response following ileostomy closure after ileal pouch-anal anastomosis: a deeper dive into a rare entity. Int J Colorectal Dis 35, 2267–2271 (2020). https://doi.org/10.1007/s00384-020-03710-y

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