Characteristics of Colonic Pseudo-Obstruction Post Ileostomy Reversal: A Retrospective Study and Scoping Review of the Literature

Colonic pseudo-obstruction (CPO) is characterized by dilatation of the colon without an anatomical or mechanical obstruction. There are multiple etiologies that may lead to this phenomenon, including post-major abdominal or pelvic surgery, critical illness states, drug-induced effects, and severe electrolyte imbalances, to name a few. An ileostomy closure is a commonly performed surgical procedure that restores the continuity of the gastrointestinal tract post-significant previous colorectal resection. Common complications have been known to occur, such as small bowel ileus, anastomotic leak, wound site infections; however, reports of CPO post-ileostomy closure have not been well reported or studied. This study aimed to evaluate the characteristics, management, and outcomes of patients treated for CPO after loop ileostomy closure and to identify the existing evidence in the literature on this uncommon phenomenon. We conducted a retrospective study of all patients from Princess Alexandra Hospital who developed CPO after ileostomy closure in the past 10 years. Electronic records were accessed to find patient demographic and clinical details, including primary surgery, whether or not radiation was applied, co-morbidities, as well as hospital length of stay and post-operative outcomes. Subsequently, a scoping review was conducted of literature to identify all studies reporting CPO after ileostomy closure. Comparisons were made between our results and those of the scoping review. Nine patients were included in our retrospective study. Seven patients required ileostomy after ultra-low anterior resection (ULAR) for cancer, and two patients for perforated diverticulitis. Mean time to reversal was 7.78 months. Three patients had neoadjuvant and adjuvant chemotherapy, and three patients had neoadjuvant therapy only. CPO diagnosis was made on radiological imaging, and the mean length of hospital stay for all patients was 9.5 days. Mean CPO resolution time was 4.8 days. Scoping review identified 200 studies; however, only one study qualified for inclusion. Five patients were included who underwent ULAR with ileostomy, with four patients requiring neoadjuvant and adjuvant therapy. Mean time to reversal was 8.3 months. Both the retrospective study and scoping review found similar patient characteristics in those who developed CPO post-ileostomy closure. In particular, it would appear that in an irradiated pelvis, the risk of CPO development appeared higher; however, larger patient studies are required to inform better statistical analyses and draw more correlations.