Abstract
The water and electrolyte balance was studied in 31 patients with ulcerative colitis (UC) and 22 with familial adenomatous polyposis (FAP) who underwent staged surgery involving colectomy and ileal J pouch-anal anastomosis (IAA), preoperatively, after terminal ileostomy, after high ileostomy, and after ileostomy closure. Serum electrolytes did not differ between each surgical stage. After terminal or high ileostomy, daily urine volume and urinary sodium loss was significantly lower, and daily fecal weight and fecal sodium loss was significantly higher than preoperatively. After ileostomy closure, urinary and fecal sodium loss became closer to preoperative value. Daily urinary potassium loss was significantly higher and fecal loss was lower after terminal and high ileostomy than preoperatively and did not show a significant change after ileostomy closure. The urinary sodium to potassium ratio after ileostomy closure was lower than preoperatively, but was higher than that after terminal and high ileostomy. Plasma aldosterone and renin levels were only significantly increased after high ileostomy. These findings indicate that high or terminal ileostomy caused chronic dehydration, which was compensated for by activation of the renin-aldosterone axis, while the water and electrolyte balance became closer to normal after ileostomy closure following ileoanal anastomosis.
Résumé
Un bilan hydro-électrolytique a été établi chez 31 patients porteurs d'une recto-colite ulcéro-hémorragique et 22 porteurs d'une polypose familiale; tous avaient subi plusieurs temps chirurgicaux comprenant une colectomie et la confection d'une anastomose iléoanale avec une pochen en J. Les dosages ont été réalisés à 4 péeriodes au cours du suivi chirurgical, en particulier en préopératoire, après la colectomie avec confection d'une iléostomie terminale, après l'anastomose iléo-anale sous couvert d'une iléostomie de protection et après fermeture de l'iléostomie de protection. Les taux sériques d'électrolytes ne diffèrent pas entre les 4 périodes chirurgicales. Après iléostomie terminale ou après iléostomie de protection, le volume urinaire quotidien et les pertes de sodium urinaire étaient significativement plus basses alors que le poids fécal quotidien et les pertes de sodium fécales étaient significativement plus élevées qu'en préopératoire. Après fermeture de l'iléostomie, les valeurs d'excrétion du sodium urinaire et fécal étaient voisines à celles de la valeur pré-opératoire. L'élimination journalière de potassium par les urinaires était plus élevée et les pertes fécales plus basses après iléostomie terminale et iléostomie de protection que celles observées en préopératoire; ces valeurs ne changeaient pas de manière significative après fermeture de l'iléostomie. Le rapport sodium/potassium urinaire après fermeture de l'iléostomie est abaissé par rapport à la valeur pré-opératoire mais demeure plus élevé qu'après iléostomie terminale et iléostomie de protection. Le taux d'aldostérone et le taux de rénine plasmatique étaient significativement augmentés après une iléostomie de protection. Ces données tendent à démontrer qu'une iléostomie terminale ou une iléostomie de protection favorisent une déshydratation chronique avec une perte sodique compensée par l'activation du mécanisme rénine-aldostérone.
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Okamoto, T., Kusunoki, M., Kusuhara, K. et al. Water and electrolyte balance after ileal J pouch-anal anastomosis in ulcerative colitis and familial adenomatous polyposis. Int J Colorect Dis 10, 33–38 (1995). https://doi.org/10.1007/BF00337584
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DOI: https://doi.org/10.1007/BF00337584