Surgery III

Question 1

High Output Stoma

Answer 1

A high-output stoma (HOS) or fistula is when small bowel output causes water, sodium and often magnesium depletion

The nutritional support and treatment for High Output Stoma (HOS) is dependent upon: Length of Bowel to Stoma

Medical Management

Once active disease or infection has been excluded, then a reduction in stoma output can be achieved by:

1. Reduction in hypotonic fluids to 500ml/day
2. Reduction in gut motility with high dose loperamide and codeine phosphate
3. Reduction in secretions with high dose proton pump inhibitors (a twice daily dose)
4. Use of WHO solution to reduce sodium losses
5. Low fibre diet to reduce intraluminal retention of water