Temporary Ileostomy for Inflammatory Bowel Disease

Benefits and Indications

Subtotal colectomy with ileostomy is the emergency operation of choice for severe acute and refractory colitis, with both open and laparoscopic approaches appropriate depending on the patient's hemodynamic stability, as recommended by the World Journal of Emergency Surgery 1, 2
A temporary ileostomy can effectively divert the fecal stream, allowing for remission of colonic inflammation and providing time for intensified medical therapy, according to the Journal of Crohn's and Colitis 3
Severe acute refractory colitis not responding to medical treatment is an indication for temporary ileostomy, as stated by the World Journal of Emergency Surgery 4
Toxic megacolon with clinical deterioration and biological signs of deterioration after 24-48 hours of medical treatment is an indication for temporary ileostomy, as recommended by the World Journal of Emergency Surgery 4
Massive colorectal hemorrhage in patients with acute severe ulcerative colitis is an indication for temporary ileostomy, as stated by the World Journal of Emergency Surgery 4
Free perforation and purulent/fecal peritonitis in hemodynamically stable patients is an indication for temporary ileostomy, as recommended by the World Journal of Emergency Surgery 1
Severe sepsis/septic shock requiring damage control surgery is an indication for temporary ileostomy, as stated by the World Journal of Emergency Surgery 1

Restoration of bowel continuity can be considered after 2-3 months when complete resolution of colonic inflammation is achieved, as recommended by the Journal of Crohn's and Colitis 3
A laparoscopic approach, if local expertise allows, may reduce length of hospital stay and risk of infectious complications, as stated by the World Journal of Emergency Surgery 1, 2
In hemodynamically unstable patients or those with free perforation and generalized peritonitis, an open approach is recommended, as stated by the World Journal of Emergency Surgery 4
For patients with severe sepsis/septic shock, damage control surgery with resection, stapled off bowel ends, and temporary closure with return to theater in 24-48 hours may be considered, as recommended by the World Journal of Emergency Surgery 1

Delaying surgery in critically ill patients presenting with toxic megacolon should be avoided, as stated by the World Journal of Emergency Surgery 4
Attempting primary anastomosis in patients with 2 or more risk factors for anastomotic complications should be avoided, as recommended by the World Journal of Emergency Surgery 1
Prolonged maintenance of a diverting ileostomy without a clear plan for either restoration of continuity or definitive surgery should be avoided, as stated by the Journal of Crohn's and Colitis 3
Performing ileal pouch-anal anastomosis in Crohn's disease patients with a history of perianal or small bowel disease should be avoided, as recommended by the Journal of Crohn's and Colitis 5, 6