Liang YK, Zhang JH, Liang S, Wu SW, Feng XY. Loop ileostomy-induced reversible nonalcoholic fatty liver disease in a rectal cancer patient: A case report and review of literature. World J Gastrointest Surg 2026; 18(4): 115698 [DOI: 10.4240/wjgs.v18.i4.115698]
Corresponding Author of This Article
Xue-Yi Feng, MD, PhD, Department of General Surgery, Lu’an Hospital of Anhui Medical University (Lu’an People’s Hospital of Anhui Province), No. 21 West Wanxi Road, Lu’an 237005, Anhui Province, China. fxy514270277@126.com
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Surgery
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Case Report
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Apr 27, 2026 (publication date) through Apr 24, 2026
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World Journal of Gastrointestinal Surgery
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Liang YK, Zhang JH, Liang S, Wu SW, Feng XY. Loop ileostomy-induced reversible nonalcoholic fatty liver disease in a rectal cancer patient: A case report and review of literature. World J Gastrointest Surg 2026; 18(4): 115698 [DOI: 10.4240/wjgs.v18.i4.115698]
World J Gastrointest Surg. Apr 27, 2026; 18(4): 115698 Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.115698
Loop ileostomy-induced reversible nonalcoholic fatty liver disease in a rectal cancer patient: A case report and review of literature
Yong-Kang Liang, Ju-He Zhang, Song Liang, Shen-Wei Wu, Xue-Yi Feng
Yong-Kang Liang, Ju-He Zhang, Song Liang, Shen-Wei Wu, Xue-Yi Feng, Department of General Surgery, Lu’an Hospital of Anhui Medical University (Lu’an People’s Hospital of Anhui Province), Lu’an 237005, Anhui Province, China
Co-first authors: Yong-Kang Liang and Ju-He Zhang.
Co-corresponding authors: Shen-Wei Wu and Xue-Yi Feng.
Author contributions: Liang YK and Zhang JH contributed equally to manuscript writing and editing, and data collection; they made equal contributions; Liang S contributed to conceptualization and supervision; Feng XY and Wu SW contributed equally to revising the article and supervision; all authors have read and approved the final manuscript.
Supported by Bengbu Medical University Research Fund, No. 2024byzd288.
Informed consent statement: Written informed consent was obtained from the participant for both participation and publication of clinical data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Xue-Yi Feng, MD, PhD, Department of General Surgery, Lu’an Hospital of Anhui Medical University (Lu’an People’s Hospital of Anhui Province), No. 21 West Wanxi Road, Lu’an 237005, Anhui Province, China. fxy514270277@126.com
Received: October 24, 2025 Revised: December 4, 2025 Accepted: February 12, 2026 Published online: April 27, 2026 Processing time: 183 Days and 0.7 Hours
Abstract
BACKGROUND
Loop ileostomy is routinely performed in colorectal surgery to decrease the risk of anastomotic leakage. Its short- and long-term complications, such as renal impairment, dehydration, and microbial dysbiosis, are well recognized, but its potential metabolic effects have been largely overlooked. Notably, the development and spontaneous resolution of nonalcoholic fatty liver disease (NAFLD) in association with loop ileostomy has not been previously documented.
CASE SUMMARY
A 41-year-old man with a 2-month history of hematochezia underwent laparoscopic total mesorectal excision with loop ileostomy, followed by six cycles of adjuvant oxaliplatin and capecitabine chemotherapy. Surveillance computed tomography at 6 months and 9 months postoperatively showed new-onset hepatic steatosis, with no evidence of alcohol use or other secondary causes. Ileostomy reversal was performed 9 months after initial surgery. Remarkably, hepatic steatosis resolved completely within 3 months following stoma closure. During this period, serial assessments revealed dynamic changes in body mass index, serum lipid levels, and appetite scores. Postprandial levels of glucagon-like peptide-1 and peptide YY(3-36) were suppressed during ileostomy and rose significantly after reversal. These findings suggest a reversible metabolic disturbance potentially mediated by altered gut hormone signaling. At 27-month follow-up, the patient remained free of hepatic steatosis and cancer recurrence. This case highlights a previously unrecognized association between loop ileostomy and reversible NAFLD.
CONCLUSION
Loop ileostomy may induce reversible NAFLD via appetite stimulation and hormonal changes involving glucagon-like peptide-1 and peptide YY(3-36).
Core Tip: This case highlights a rare, reversible occurrence of nonalcoholic fatty liver disease following loop ileostomy in a rectal cancer patient. The temporal association between ileostomy, increased appetite, dyslipidemia, and fluctuations in glucagon-like peptide 1 and peptide YY(3-36) levels suggests a potential metabolic impact of ileostomy. These findings introduce a novel hypothesis linking gastrointestinal anatomical changes to hepatic lipid accumulation, warranting further mechanistic investigation.
