Ileostomy Prolapse in Children with Intestinal Dysmotility

Abstract

Background: A relationship between intestinal motility and ileostomy prolapse has been suggested but not demonstrated objectively.

Aims: This study evaluated the association between ileostomy prolapse and intestinal dysmotility in children.

Methods: IRB-approved retrospective review of 163 patients with ileostomies (1998-2014) at a single institution. Patients were categorized as having clinical dysmotility as a primary diagnosis (n = 33), clinically suspected dysmotility based on underlying diagnosis (n = 60), or intestinal dysmotility unlikely (n = 70) at the time of ileostomy present. Intestinal manometry was categorized as normal (n = 13) or abnormal (n = 10). Primary outcome was pathologic stoma prolapse. Multivariate analysis using a logistic regression model and log-rank test to compare stoma prolapse rates over time between motility groups were used.

Results: Clinical diagnosis of dysmotility (p ≤ 0.001) and manometric findings of dysmotility (p = 0.024) were independently associated with stoma prolapse. Clinical dysmotility correlated with manometric findings (κ = 0.53). Prolapse occurred in 42% of patients with dysmotility, 34% of patients with suspected dysmotility, and 24% of patients with normal motility. One-year prolapse-free stoma "survival" was 45% for dysmotility, 72% for suspected dysmotility, and 85% for intestinal dysmotility unlikely groups (p = 0.006).

Conclusions: Children with intestinal dysmotility are at great risk for stoma prolapse. Intestinal manometry could help identify these patients preoperatively.

Figure 1

Predicted 5-year (60-month) prolapse for patients with an ileostomy by dysmotility category. Overall, a log-rank test determined that dysmotility category significantly differed with respect to the rate of prolapse (χ² = 16.828; p < 0.001). Furthermore, a log-rank test established that confirmed dysmotility significantly differed from suspected dysmotility (χ² = 5.386; p = 0.020) and unlikely dysmotility (χ² = 16.926; p < 0.001); however, suspected dysmotility was not found to significantly differ from unlikely dysmotility (χ² = 2.511; p = 0.11).