Related Experiment Video
Updated: Mar 21, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Ileostomy for Non-Traumatic Ileal Perforations: Is this the Beginning of the End?
Rajashekara Gangappa Babu1, Adithya Malolan2, Prashanth Basappa Chowdary2
1Assistant Professor, Department of General Surgery, Bangalore Medical College and Research Institute , Bangalore, India .
Insights
Ileostomy diversion for ileal perforations is a safe option but adds morbidity. Its use is decreasing with improved surgical facilities for managing this condition.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Emergency Medicine
Background:
- Ileal perforations are a frequent surgical emergency in India, contributing significantly to mortality.
- These perforations lead to high patient morbidity, including potential need for laparotomy and stoma formation.
- Complications encompass wound infections, fecal fistulas, and stoma-related issues.
Purpose of the Study:
- To evaluate the role and outcomes of ileostomy in managing non-traumatic ileal perforations.
- Assessing the impact of ileostomy on patient morbidity and mortality.
- Determining the indications for ileostomy in ileal perforation cases.
Main Methods:
- Prospective study of 192 patients with operatively diagnosed ileal perforations (June 2012 - July 2014).
- Patients received standard resuscitation and underwent primary closure or resection/anastomosis, with or without proximal diversion ileostomy.
- Follow-up for six months to record immediate and late complications and outcomes.
Main Results:
- 192 patients studied; 170 (88.5%) were male.
- 176 patients treated without stoma, 16 with proximal diversion ileostomy.
- Overall mortality was 7.8%, not significantly different between groups. Enterocutaneous fistula occurred only in the non-ileostomy group; stomal complications in the ileostomy group.
Conclusions:
- Ileostomy diversion is a safe option for ileal perforations but introduces additional, potentially difficult-to-manage morbidity.
- The necessity for ileostomy is diminishing with advancements in surgical facilities and equipment.
- Ileostomy is indicated only in a small, select group of patients with ileal perforations.
Introduction:
Ileal perforations are a common place of occurrence in emergency operation rooms around India. They are also significant contributors to mortality in our country. They are very distressing for patients because of the high morbidity of a laparotomy and in certain cases a stoma if its necessity is felt by the operating surgeon. The nature of the disease itself predisposes to a number of complications including wound infections, faecal fistulas and complications associated with a stoma.
Aim:
To evaluate the role of ileostomy in patients with non-traumatic ileal perforation.
Materials And Methods:
A total of 192 cases of ileal perforation, diagnosed per-operatively, were prospectively studied between June 2012 and July 2014. Cases were treated according to standard resuscitation protocols and underwent repair of the ileal perforation either as primary closure or as a bowel resection and anastomosis with or without a proximal diversion ileostomy. Cases were followed up for a period of six months and immediate and late complications and outcomes were noted.
Results:
A total of 192 patients were studied during the given study period out of which 170 (88.5%) were males. The disease was treated primarily without diversion stoma in 176 patients and in 16 patients a proximal diversion ileostomy was performed. The overall mortality was 15 (7.8%) that was noted to be not significantly different in patients with respect to the performance of a stoma. Enterocutaneous fistula was a complication seen exclusively in the non-ileostomy group whereas stomal complications were expectedly noted only in the stoma group.
Conclusion:
The authors found that though conventional ileostomy diversion may appear a safe option in patients with ileal perforations, it has its own additional morbidity, which at times can be very difficult to manage. An ileostomy is of use in a very small group of patients that is diminishing as better facilities and equipment are obtained to manage this dreaded disease.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:24Ostomy Care
An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.
There are different types of ostomies, including colostomies, ileostomies, and urostomies:
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...