Stoma Complications

Question 1

Early Stoma Complications

Answer 1

w/i 30 days

Mucocutaneous separation, necrosis, retraction

Question 2

Mucocutaneous separation

Answer 2

Detachment of stoma from peristomal skin and mucocutaneous junction
2nd to tension, infection, and - healing
Partial or complete, superficial or full thickness
Treat as wound (hydrofiber, calcium alginate)
Pouch entire area
Severe separation = retraction
+ risk of stenosis while healing
If fascia involved: fecal effluent may contaminate ABD = peritonitis

Question 3

Stomal Necrosis

Answer 3

2nd tension or inadequate mesenteric vasculature or trauma
Associate w/ obesity & traction on bowel wall
Progressive discoloration pink to black
Dusky/dry w.i hours/days of surgery
Superficial or deep

Question 4

Stomal Necrosis: Treatment

Answer 4

1. Insert lubricated glass tube into stoma and shine penlight into stoma to determine depth
2. Intraoperative laser angiography w/ indocyanine green
   - vascular imaging/real-time assessment of perfusion
3. Watch and wait. Top layer may slough off if superficial
4. Debride if below skin level but above fascia
5. If deeper than fascia, sergeant surgical intervention

Question 5

Stomal retractions

Answer 5

2nd to tension from short mesentery
Thickened ABD wall
Adhesions and scar tissue
\+BMI 
Inadequate stoma length
Necrosis
Mucocutaneous separation
- Use convexity or belt

Question 6

Late stomal complications

Answer 6

30+ post-creation

Stenosis, prolapse, parastomal herniation

Question 7

Stomal stenosis

Answer 7

2nd mucocutaneous separation, necrosis, retraction
Granulation tissue constricts lumen as healing occurs
Risks: Crohn’s, tumor, + scar tissue, chronic inflammation

Question 8

Fecal Stomal Stenosis: s/s

Answer 8

Small stoma opening
Pain w/ evacuation
Ribbon-like or explosive stool
Explosive, loud gas

Question 9

Urinary Stomal Stenosis: s/s

Answer 9

Freq UTI
Projectile stream
Flank pain

Question 10

Stomal stenosis: treatment

Answer 10

Use finger to assess size and mobility of opening
Mild, - residue diet
Stool softener
\+ liquid intake
Stoma dilation is temporary only!
If severe, freeze or resite stoma

Question 11

Stomal Prolapse

Answer 11

Telescoping of intestine through stoma
2nd ABD pressure, obesity, large stomal opening, stoma outside rectus muscle
Most common in loop colostomy
+ length of prolapse = + chance of stomal edema, trauma, ischemia
Edemetous and dependent stoma = deep red (vasodilation)

Question 12

Stomal Prolapse: Treatment

Answer 12

Palpate w/ pt supine to - prolapse
Apply ice
Sprinkle sugar on stoma
Wear hernia support belt w/ prolapse strap
Pouch must accommodate prolapse
1 piece system if large prolapse

Question 13

Stomal hernia

Answer 13

Defect in ABD fascia allows bulging of intestine
Common @ inguinal ring, umbilicus, esophageal hiatus
2nd + pressure, obesity

Question 14

Stomal Hernia: s/s, tx

Answer 14

Bulging around stoma, difficulty maintaining seal
Assess pt supine and coughing
Xray
Flexible pouching system, 0 convexity, hernia support, spandex, prevent constipation
Surgery if obstruction, stenosis, dermatitis, pain