STOMA COMPLICATIONS

Many pathological conditions can necessitate the need for some type of bowel or urinary diversion known as an ostomy. For the most part, ostomies are well managed by the patient, and/or caregiver. Sometimes complications can occur. A list of basic stoma complications follows:

Necrosis— A dark, black stoma due to inadequate blood supply. This can be caused by excessive tension on the mesentery, too thick of an abdominal wall for the intestines to pass through, too tight a suture line, or interruption of blood flow (clot). Management is based on the extent of necrosis. Superficially—– continual monitoring: it may slough off and can be managed with a modified pouching system. If it is below the fascia level, it often requires stoma reconstruction.

Detachment — The stoma separates completely from the adjoining skin. This is caused by too much tension on the mesentery and requires surgical revision of the stoma.

Recession—Retraction — Sinking of the stoma below the skin level. This can be caused by scar formation secondary to mucocutaneous separation, necrosis, peristomal skin problems, weight gain, radiation, recurrent malignancies, or excessive tension on the suture line. This can be medically managed with a modified pouching system. Severe cases may require stoma revision.

Stenosis—Strictures—– Extreme narrowing of the stoma that can threaten the normal function of stool evacuation. Multiple causes can include inadequate suturing at the fascia level, mucocutaneous separation, edema, and disease conditions which may cause scar formation that compress the stoma causing ribbon-like stool or obstruction. This may be medically managed with stoma dilation or require surgical intervention.

Prolapse — Telescoping of the bowel out through the stoma. Poor abdominal wall support and increased abdominal pressure from coughing, sneezing, laughing, or tumor formation are common risk factors. Conservative management of a prolapse includes reduction of protrusion by gentle pressure, cool wash cloth and even sugar (acts as an osmotic diuretic) on the stoma, then applying a binder or prolapse belt. In some cases, prolapse is medically managed if the patient is considered a surgical risk.

Hernia — Protrusion of the bowel into the subcutaneous tissue around the stoma. This is characterized by a bulge in the abdominal wall or tension on the abdominal wall or on the abdominal muscle. This is medically managed by wearing a binder and/or modified pouching system. If herniation leads to a blockage, surgical intervention is required. To aid in prevention of a hernia, wear a binder especially when lifting heavy objects, or guarding the stoma with a hand pillow when coughing or laughing. One noted entertainer places a hand over his side, guarding the stoma when laughing.

Obstruction — Blockage of a stoma from recurrent disease process, or twisting-kinking of a loop of bowel in the abdomen. Surgical intervention is required.

Impaction — (In colostomates). Stoma clogged by hard stool requiring stool softening with enema or a small amount of oil prior to stoma irrigation. Impaction may be prevented by drinking 8 to 10 glasses of fluid per day, attention to diet and regular use of stool softeners.



From: North Texas Ostomy News Via: Sherman Area Ostomy Assoc.