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The effect of faecal diversion on human ileum
  1. Leith Williams (leith.a{at}virgin.net)
  1. Leeds General Infirmary, United Kingdom
    1. Matthew Armstrong (mattyarm{at}hotmail.com)
    1. Leeds General Infirmary, United Kingdom
      1. Paul Finan
      1. Leeds General Infirmary, United Kingdom
        1. Peter Sagar
        1. Leeds General Infirmary, United Kingdom
          1. Dermot Burke (d.burke{at}leeds.ac.uk)
          1. Leeds General Infirmary, United Kingdom

            Abstract

            Background and aims The use of a loop ileostomy is an effective method to protect pelvic anastomoses. Its use has increased recently, although there is some debate as to the routine use of a stoma. Reversal of the ileostomy is associated with a significant morbidity, which may be related to impaired function of the bypassed distal limb of ileum. The aim of our study was to investigate the changes that might occur in the distal limb after an interval of faecal diversion.

            Methods Full thickness intestinal circular muscle strips were prepared from excised loop ileostomies taken at the time of closure. The study sample was from the distal limb and the control from the proximal limb. Contractile activity was measured using an organ bath set up to record isometric contraction after stimulation by acetylcholine. Histological sections were assessed for an index of villous atrophy, smooth muscle area and nerve and vessel density. Analysis was with the Wilcoxon signed ranks test for paired data and the Mann-Whitney U test for unpaired data.

            Results Samples were acquired prospectively from 35 consecutive patients. The median time between formation and closure of ileostomy was 34 weeks. There was a significant reduction in the strength of circular muscle contraction, smooth muscle area, and median villous index of the distal limb compared to the proximal limb.

            Conclusion Impaired intestinal function has been proposed as a contributory factor in the morbidity that may follow closure of loop ileostomy. We have shown that significant loss of contractility and smooth muscle strength and villous atrophy occur in the distal ileal limb after faecal diversion. Methods of preventing these changes should be considered.

            • Closure
            • Contractility
            • Histology
            • Ileostomy
            • Villous Atrophy

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              BMJ Publishing Group Ltd and British Society of Gastroenterology