Known complication of stoma (e.g., Colostomy stomach)
Stomal Complication: Stomas are widely used in the treatment of colorectal, Intestinal and urological diseases An intestinal stoma can be an ileostomy, colostomy, or urostomy, endloop, or temporary or permanent, diveing or decompressing, or continent or incontinent A tube cecostomy and a blow hole are considered temporary decompressing colostomies performed in emergencies Technical factors are most impoant in minimizing the complication rate of stoma construction and are largely preventable Early complications are considered those that occur within 30 days after surgery Clinical Presentation and Diagnosis Ischemic Necrosis From impaired perfusion to the terminal poion of the bowel as a result of a tight apeure, overzealous trimming of mesentry, or mesenteric tension Stomal retraction Occurs early as a result of tension on the bowel or ischemic necrosis of the stoma Late retraction Caused by increased thickness of the abdominal wall with weight gain Stenosis As a result of a small apeure (natural maturation), ischemia, recurrence of Crohn&;s disease or development of carcinoma Mucocutaneous seperation As a result of ischemia, inadequate approximation of mucosa to the dermal layer of skin, excessive bowel tension Stomal prolapse Most alarming to the patient and can result inn incomplete diversion of stool, interfere with the stoma appliance, lead to leakage of stool, or become associated with obstructive symptoms and incarceration Parastomal fistula Occurs to some degree in most patients Peristomal fistula Sign of Crohn&;s disease may result from a deep suture used to mature the stoma, or may be caused by trauma from an appliance Chemical dermatitis Caused by contact of the stoma effluent with peristomal skin Manisfested as erythema, ulceration (ileostomy effluent), encrustation(urostomy effluent), or pseudoepitheliomatous hyperplasia Traumatic dermatitis Occurs during change of the stomal device, from stripping of adhesive, or as a result of friction or pressure from the stomal device or suppoive belt manifested as erythema, erosion and ulceration Diarrhoea and dehydration Commonly occurs in older patients in hot weather, during strenous excercise, and in association with sho bowel syndrome Cutaneous manifestations of the disease Damaged peristomal skin in psoriasis Pyoderma gangrenous in IBD Parastomal varices in poal hypeension Ref: Sabiston 20th edition Pgno: 1326
Prolapse
Stenosis
Retraction
All of the above
G.I.T