Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end
jejunoileal bypass for
obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry
fistula. Weight prior to
jejunoileal bypass was 130 kg (287 pounds). Before
ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for
ileostomy were three episodes of
blind loop syndrome and three episodes of severe
bleeding from the ileotransverse
colostomy anastomotic site. Culture of the bypassed segment at
laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After
ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the
ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the
ileostomy include: (1) better sense of well being; (2) no further episodes of
blind loop syndrome or intestinal
bleeding; and (3) cessation of anal
itching. Nine months after
ileostomy,
hyperoxaluria and acquired
megacolon were present. Weight was 5.9 kg (13 pounds) greater than before
ileostomy.