The case of spontaneous stoma closure in patient with loop ileostomy

An ileostomy is a mean to empty the contents of the bowel via ileum rather than usual anal route to prevent distal anastomotic leak. It is considered a controlled entero-cutaneous (EC) fistula which prevents contamination of peritoneal cavity, protecting the peri-stomal skin from effluent and excoriation. Spontaneous closure of ileostomy is a very rare phenomenon. Thus, we hereby report a case of spontaneous closure of ileostomy.

An 18-years male presented with complaints of pain abdomen, vomiting for 6 days. Chest X-ray showed free air under the right dome of diaphragm suggestive of pneumo-peritoneum. So explorative laparotomy with primary repair of ileal perforation with diversion loop ileostomy (2 ft proximal to ileocecal junction) was performed. Over the months stoma retracted and eventually spontaneous closure of stoma took place after 4 months of surgery.

Retraction of stoma depends on multiple factors. Firstly, on patient's general condition, if he/she is malnourished/obese/immunocompromised then retraction occurs due to poor healing of wound. Secondly, it results from inadequate mobilization of bowel. Separation of stoma with muco-cutaneous fascial planes leads to gradual retraction of stoma which is primary mechanism of spontaneous closure of stoma.

To summarize, gradual retraction of stoma (complication of an ileostomy) and healing of EC fistula has to be correlated to know the complex mechanism of spontaneous closure of an ileostomy.