Diagnosing and Managing the High-Output Ileostomy: A Comprehensive Narrative Literature Review.

PURPOSE: Excessive fluid loss from a high-output ileostomy can lead to dehydration, electrolyte abnormalities, acute kidney injury, and readmissions. Yet, few guidelines exist to standardize management of this common complication. This narrative review aimed to systematically summarize the current literature on the evaluation, prevention, and treatment of high ileostomy output. METHODS: PubMed and Cochrane Library were searched using keyword and MeSH search terms. Studies were included if they were relevant to (1) adult patients with a new or existing ileostomy and (2) high ileostomy output. Articles which addressed dehydration and/or acute kidney injury after ileostomy creation were also included as surrogates for high ileostomy output. One hundred twenty-nine articles met eligibility criteria for consideration for inclusion in the final review. RESULTS: A high-output ileostomy was reported in 16% of patients after ileostomy creation. The most common complications reported included dehydration (9-39% readmission rate) and acute kidney injury (33% readmission rate), with risk of progression to chronic kidney disease. Treatments included dietary interventions such as restricting hypotonic fluids and using an oral rehydration solution; pharmacologic therapies to reduce motility and gastrointestinal secretions; and perioperative pathways with standardized patient education. CONCLUSION: Evidence-based protocols for prevention and treatment of HOI may decrease rates of dehydration, AKI, and readmission after ileostomy creation. The limitations of this review are the lack of randomized controlled or high-quality data and variation in the definition of outcomes.