Impairment of `ileostomy adaptation' in patients after ileal resection

Abstract

Ileostomists claim that in the months following the establishment of an ileostomy, the faecal output decreases in volume and becomes less fluid. It is claimed that this `ileostomy adaptation' does not occur in those patients who have had an ileal resection. To determine whether ileostomy adaptation does occur and to examine its physiological mechanisms, 10 ileostomy patients were studied. Five had had ileal resection and five had not. The output of fluid, sodium, and potassium from the ileostomy was studied in each patient for the first 11 days after ileostomy and again at six months. Those patients in whom the terminal ileum was preserved had small faecal outputs of fluid and sodium from the outset, and the water content of the effluent was significantly less at six months. After rapid expansion of the extracellular fluid by intravenous saline, there was a marked increase in faecal volume and sodium output. In those patients with an ileal resection, the faecal volume and sodium output were more than two and a half times greater than those for the non-resected group. At six months there was no change in either the volume or chemistry of the effluent. After intravenous saline, no faecal response was observed. It is therefore concluded that ileostomy adaptation does occur and it is a response of the intestine to conserve body salt. This response is lacking in ileostomists who have had an ileal resection.