Use of a novel chyme reinfusion device during damage control surgery to improve nutritional status in a patient with a proximal ileostomy: A video vignette

Chyme reinfusion is a safe and effective option to reduce morbidity when a high-output double enterostomy or enterocutaneous fistula is present [1]. In this Video S1 we present the use of The Insides System as an extension of damage control surgery procedures to avoid worsening of a patient's condition after creation of a proximal ileostomy. This device, which has already been proven to be effective, safe, user friendly and clinically acceptable in diverse situations, is utilised for the first time as a planned preoperative strategy in an urgent setting [2]. A female who has a history of kidney transplantation needs an intestinal resection because of a perforation which occurred during R-CHOP chemotherapy administration for a large B-cell lymphoma. Immediate intestinal continuity restoration is ruled out and an ileostomy needs to be performed. In this Video S1 we explain why, in urgent settings, planning a loop or double barrel ileostomy could be crucial in extremely frail patients where the high output could lead to hydroelectrolytic imbalance and acute kidney injury. This kind of stoma allowed effective and uncomplicated chyme reinfusion with the Insides System. The device was well tolerated and allowed the maintainance of an acceptable renal function without the need for parenteral fluid infusion. After 4 months of at-home self chyme reinfusion a stoma reversal surgery was performed without complications.