• High-output stoma
• Low anterior resection syndrome
• Preventive stoma
• Rectal cancer

• Humans
• Rectal Neoplasms/surgery
• Male
• Female
• Retrospective Studies
• Middle Aged
• Risk Factors
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Aged
• Surgical Stomas/adverse effects
• Ileostomy/adverse effects
• Syndrome
• Proctectomy/adverse effects
• Adult
• Logistic Models
• Low Anterior Resection Syndrome

• 20230828 Hebei Province Medical Science Research Key Project

• Attitudes
• Colorectal surgery
• High output stoma
• Knowledge
• Practices

• Humans
• Ileostomy
• Cross-Sectional Studies
• Health Knowledge, Attitudes, Practice
• Clinical Competence
• Surveys and Questionnaires
• Colorectal Neoplasms/surgery
• Attitude of Health Personnel
• Nurses

• Ileostomy
• Jejunostomy
• Meta-analysis
• Postoperative complications
• Short bowel syndrome

• Adult
• Humans
• Retrospective Studies
• Prospective Studies
• Surgical Stomas/adverse effects

• dehydration
• electrolyte profile
• energy balance
• ileostomy
• nutritional status

• Dehydration
• High output stoma
• High output syndrome
• Small bowel obstruction
• Stoma outlet obstruction
• Stoma-related obstruction

• Humans
• Ileostomy/adverse effects
• Surgical Stomas/adverse effects
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/therapy
• Incidence
• Magnesium
• Retrospective Studies

Background: Clostridioides Difficile is a well-known pathogen causing diarrhea of various degrees of severity through associated infectious colitis. However, there have been reports of infectious enteritis mainly in patients with ileostomy, causing dehydration through high-output volume; Case presentation: We report the case of a 46-year-old male patient, malnourished, who presented with high-output ileostomy following a recent hospitalization where he had suffered an ileo-colic resection with ileal and transverse colon double ostomy, for stricturing Crohn’s disease. Clostridioides Difficile toxin A was identified in the ileal output confirming the diagnosis of acute enteritis. Treatment with oral Vancomycin was initiated with rapid reduction of the ileostomy output volume; Conclusion: We report a case of Clostridioides Difficile enteral infection as a cause for high-output ileostomy, successfully treated with oral Vancomycin. We also review the existing literature data regarding this specific localized infection.

• Dehydration
• Ileostomy
• Patient readmission

• IBD Surgery
• malabsorption
• nutritional support
• short bowel syndrome
• surgical complications

• Diverting ileostomy
• High output stoma
• Organ/space infection
• Outlet obstruction

• Diarrhea
• ileostomy
• ostomy
• postoperative complications

High-output syndrome (HOS) is a complication of ileostomy, which can affect quality of life significantly; however, its exact cause remains unknown. The aim of this study was to establish the frequency, as well as the preoperative and intraoperative factors predictive of HOS.

The subjects of this study were 164 consecutive patients who underwent colorectal cancer surgery with ileostomy construction at our institute between January, 2011 and August, 2018. Thirteen patients with postoperative complications reported as causes of HOS, including intraperitoneal abscess, paralytic ileus, and outlet obstruction, were excluded. We used a logistic regression analysis to identify the factors predictive of HOS.

HOS developed in 36 of the 151 patients (23.8%). There were significantly more diabetic patients in the HOS group (P = 0.03), but other patient factors such as age, gender, body mass index, and use of daily laxatives were not significantly different between the groups. The HOS group had significantly more cases of total proctocolectomy (P = 0.04), but other surgical factors such as operative time, and blood transfusion were not significantly different between the two groups.

These results indicate that diabetes and total proctocolectomy are preoperative predictors of HOS, allowing for the possibility of early intervention via post-surgical treatment.

• Colorectal cancer
• High-output stoma
• Ileostomy
• Predictive factors

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/surgery
• Diabetes Mellitus
• Female
• Forecasting
• Humans
• Ileostomy/adverse effects
• Logistic Models
• Male
• Middle Aged
• Postoperative Complications
• Proctocolectomy, Restorative
• Retrospective Studies
• Risk Management
• Surgical Stomas/adverse effects
• Syndrome
• Young Adult

Introduction. Clostridium difficile is the most common cause of healthcare associated infectious diarrhea, and its most common clinical manifestation is pseudomembranous colitis. Small bowel enteritis is reported infrequently in the literature and typically occurs only in patients who have undergone ileal pouch anastomosis due to inflammatory bowel disease or total abdominal colectomy for other reasons. Presentation of Cases. We report here two cases in which patients developed small bowel C. difficile enteritis in the absence of these underlying conditions. Discussion. Neither patient had underlying inflammatory bowel disease and both had a significant amount of colon remaining. Conclusion. These two cases demonstrate that small bowel C. difficile enteritis should be included in the differential diagnosis of patients on antibiotic therapy who demonstrate signs and symptoms of worsening abdominal disease during their postoperative course, even if they lack the major predisposing factors of inflammatory bowel disease or history of total colectomy.

An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management.

This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery.

Early HOS was observed in 7 (16 %) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16 %) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100 % effectiveness. 50 % of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33 % of the late HOS patients.

The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibodies/therapeutic use
• Bacteremia/epidemiology
• Bacteremia/microbiology
• Child
• Clostridioides difficile/isolation & purification
• Clostridium Infections/drug therapy
• Clostridium Infections/epidemiology
• Clostridium Infections/etiology
• Comorbidity
• Cross Infection/epidemiology
• Cross Infection/microbiology
• Female
• Gastrointestinal Tract/microbiology
• Gastrointestinal Tract/surgery
• Humans
• Male
• Medical Records/statistics & numerical data
• Microbial Sensitivity Tests
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/microbiology
• Retrospective Studies
• Wounds and Injuries/epidemiology
• Wounds and Injuries/microbiology
• Young Adult

• Clostridium difficile
• Diagnosis and management
• Pathophysiology
• Risk factors
• Small bowel

• Child
• Clostridioides difficile/isolation & purification
• Clostridium Infections/diagnosis
• Clostridium Infections/epidemiology
• Clostridium Infections/microbiology
• Community-Acquired Infections/diagnosis
• Community-Acquired Infections/epidemiology
• Community-Acquired Infections/microbiology
• Humans
• Incidence
• Risk Factors

Clostridium difficile (C. difficile) is the most common cause of healthcare associated infectious diarrhea. In the last decade, the incidence of C. difficile infection has increased dramatically. The virulence of C. difficile has also increased recently with toxigenic strains developing. C. difficile is generally a disease of the colon and presents with abdominal pain and diarrhea due to colitis. However, C. difficile enteritis has been reported rarely. The initial reports suggested mortality rates as high as 66%. The incidence of C. difficile enteritis appears to be increasing in parallel to the increase in colonic infections. We present two cases of patients who had otherwise uneventful abdominal surgery but subsequently developed C. difficile enteritis. Our literature review demonstrates 81 prior cases of C. difficile enteritis described in case reports. The mortality of the disease remains high at approximately 25%. Early recognition and intervention may reduce the high mortality associated with this disease process.

• Clostridium difficile
• Enteritits
• Antibiotics
• Colorectal surgery
• Nosocomial infection

High output ileostomies are important complications of stoma formation following bowel surgery. Adequate management of such stomas might prevent severe morbidity and mortality when this potentially fatal complication develops. In this case report, we describe a female patient with a recent ileostomy formation following panproctocolectomy for ulcerative colitis who presented with progressively increasing shortness of breath. The patient was found to have a hypochloraemic metabolic acidosis on arterial blood gases. She rapidly improved with adequate sodium and fluid replacement and with the use of a course of proton pump inhibitors. This case highlights the importance of recognising high output ileostomies early and important management issues in their regard.

• Gastrin
• Loop ileostomy
• Proton pump inhibitors
• Ulcerative colitis