Ileostomy Prolapse in Children with Intestinal Dysmotility
Eric A Sparks1,2, Cristine S Velazco1,2, Brenna S Fullerton1,2
1Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA.
Insights
Children with intestinal dysmotility face a high risk of ileostomy prolapse. Intestinal manometry may help identify at-risk patients before surgery.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Stoma care
Background:
- The link between intestinal motility and ileostomy prolapse is suspected but lacks objective evidence.
- Ileostomy prolapse is a significant complication in pediatric patients requiring ostomy surgery.
Purpose of the Study:
- To objectively evaluate the association between intestinal dysmotility and the occurrence of ileostomy prolapse in children.
- To determine if intestinal manometry findings correlate with clinical assessments of dysmotility and stoma prolapse risk.
Main Methods:
- Retrospective review of 163 pediatric patients with ileostomies.
- Patients classified by clinical diagnosis or suspicion of intestinal dysmotility.
- Analysis of intestinal manometry results (normal vs. abnormal) and correlation with stoma prolapse incidence.
Main Results:
- Clinical diagnosis of dysmotility and abnormal manometry were independently associated with stoma prolapse (p ≤ 0.001 and p = 0.024, respectively).
- Prolapse rates were higher in patients with dysmotility (42%) compared to suspected (34%) or unlikely dysmotility (24%).
- One-year prolapse-free survival was significantly lower in the dysmotility group (45%) versus others (p = 0.006).
Conclusions:
- Children with diagnosed intestinal dysmotility are at significantly increased risk for ileostomy prolapse.
- Intestinal manometry can aid in identifying pediatric patients with high prolapse risk preoperatively.
- Early identification and management strategies may be warranted for children with intestinal dysmotility and ileostomies.
Background:
A relationship between intestinal motility and ileostomy prolapse has been suggested but not demonstrated objectively.
Aims:
This study evaluated the association between ileostomy prolapse and intestinal dysmotility in children.
Methods:
IRB-approved retrospective review of 163 patients with ileostomies (1998-2014) at a single institution. Patients were categorized as having clinical dysmotility as a primary diagnosis (n = 33), clinically suspected dysmotility based on underlying diagnosis (n = 60), or intestinal dysmotility unlikely (n = 70) at the time of ileostomy present. Intestinal manometry was categorized as normal (n = 13) or abnormal (n = 10). Primary outcome was pathologic stoma prolapse. Multivariate analysis using a logistic regression model and log-rank test to compare stoma prolapse rates over time between motility groups were used.
Results:
Clinical diagnosis of dysmotility (p ≤ 0.001) and manometric findings of dysmotility (p = 0.024) were independently associated with stoma prolapse. Clinical dysmotility correlated with manometric findings (κ = 0.53). Prolapse occurred in 42% of patients with dysmotility, 34% of patients with suspected dysmotility, and 24% of patients with normal motility. One-year prolapse-free stoma "survival" was 45% for dysmotility, 72% for suspected dysmotility, and 85% for intestinal dysmotility unlikely groups (p = 0.006).
Conclusions:
Children with intestinal dysmotility are at great risk for stoma prolapse. Intestinal manometry could help identify these patients preoperatively.
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