Supplementary Material for: Early onset outlet obstruction of a temporary diverting loop ileostomy secondary to urinary retention

A mechanical obstruction is not a physiological entity and when it occurs within the 30-day postoperative period, is called an early postoperative small bowel obstruction. Kinking of small bowel segments at the ileostomy outlet secondary to a distended bladder is an unusual source of early postoperative small bowel obstruction. A 36-year-old female underwent a redo J-Pouch surgery and creation of loop ileostomy after pouch failure related to recurrent small bowel obstruction and perianal fistulae. Her foley catheter was removed on postoperative day three and she passed a trial of void test. On postoperative day six, the abdomen became progressively more distended. CT imaging with IV contrast showed small bowel distension extending to the midline anterior to the urinary bladder where it demonstrated a narrowed lumen. These findings were thought to be the cause of small bowel obstruction at this level before the ileostomy. Immediately after CT, a foley catheter was applied with which two liters of urine was removed and consequently gas and stool were observed in the ostomy soon thereafter. Although rare, urinary retention may cause intestinal obstruction, especially in the presence of a loop ileostomy in close proximity.

机械性肠梗阻（mechanical obstruction）并非一种生理状态，若其发生于术后30天内，则被定义为术后早期小肠梗阻（early postoperative small bowel obstruction）。因膀胱充盈导致回肠造口（ileostomy）出口处小肠肠段成角扭转，是术后早期小肠梗阻的一类罕见诱因。

一名36岁女性因复发性小肠梗阻及肛周瘘管引发储袋功能障碍，接受了返修J型储袋手术（redo J-Pouch surgery）并建立袢式回肠造口（loop ileostomy）。术后第3日拔除导尿管（Foley catheter），患者顺利通过排尿试检。术后第6日，患者出现进行性腹胀。静脉增强CT（CT imaging with IV contrast）检查显示小肠扩张延伸至膀胱前方正中线处，该部位肠腔可见狭窄。上述影像学表现被判定为回肠造口近端该水平小肠梗阻的病因。完成CT检查后立即重新置入导尿管，引流出2000ml尿液，随后造口处很快排出气体及粪便。

尽管此类情况较为罕见，但尿潴留（urinary retention）可引发肠梗阻，在造口位置邻近膀胱的患者中尤需警惕。