Distal infusion stomal enteroclysis: An effective technique to manage postoperative enterostomal output

Abstract

Background

High output enterostomy leads to malnutrition and fluid/electrolyte loss which may be challenging to manage despite dietary modification, anti-motility, anti-secretory drugs, and parenteral nutrition. Distal infusion stomal enteroclysis (DISE) is an alternative to restore nutritional deficit and replace parenteral nutrition in resource-limited settings where treatment cost and availability of trained nurses are limiting factors.

Objective

To assess the effectiveness and feasibility of DISE in managing postoperative enterostomal output.

Methods

Consecutive patients who met the inclusion criteria and underwent enterostomy in one year were included. Postoperatively, DISE was started after the return of bowel movement. Stomal effluent was collected, filtered, and reinfused through the distal limb using a Foley catheter. The patients and caregivers were trained to perform under supervision. At discharge, they were encouraged to maintain regular contact and advised to report back when necessary.

Results

Twenty-five patients received DISE, of which 22 were discharged and successfully continued to manage at home, while 3 expired. The median age was 36 years, the median BMI at admission and discharge was 19  and 17.8 kg/m² respectively (the difference was statistically significant), and the male: female ratio was 2.5: 1. Thirty-day readmission was done for 2 patients to manage minor complications. The average stomal output was 820 mL/day initially and 478 mL/day at discharge. The median duration of DISE was 12 days. Thirteen patients (52%) needed parenteral nutritional support due to inadequate oral intake.

Conclusion

DISE is a feasible and effective technique for managing high output enterostomies. It can be easily taught and performed with minimal resources at home.