Complications from an ostomy can occur. Most commonly, local skin irritation may occur due to contact with stool, allergy to the ostomy appliance, or skin abrasions and trauma from frequent appliance changes. These problems are generally easily treated with topical creams and ostomy care. ET nurses are a great resource to help deal with these problems.
Stenosis or narrowing of the stoma may occur due to inadequate blood flow to the stoma. This may be related to a tight stoma opening or an individual’s overall clinical condition. When a stenosis occurs in the setting of a temporary stoma, conservative management with diet modifications and if necessary stoma dilation may be performed until it is time to reverse the ostomy. When a stoma is permanent, or when conservative measures are unsuccessful resulting in recurrent stenosis and obstruction, surgical revision may be the best treatment.
Retraction of an ostomy may occur where it partly pulls back into the abdomen. This may occur due to weight gain after stoma creation or a small segment of exteriorized bowel to start with. A retracted stoma may create problems such as leakage, problems emptying and skin irritation due to poor fit of the stoma appliance. When an ostomy is temporary, non-operative management is preferred to “buy” time until the reversal surgery. This includes local wound care and using a different appliance such as a convex stoma appliance for a better fit. If the problem is not easily remedied with conservative measures or in the setting of a permanent ostomy, surgical revision of the ostomy may be necessary.
Stoma prolapse refers to the protrusion of a long segment of intestine from the ostomy. The prolapse may be easily reducible (pushed back in) or may become incarcerated (unable to be pushed back in). When this happens, immediate evaluation by your colorectal surgeon is necessary to prevent strangulation and gangrene. Initial measures for an incarcerated prolapse may be conservative including treatment with granulated sugar (to shrink and reduce the prolapse). However, surgical correction may be necessary.
A parastomal hernia is an incisional hernia that occurs at the site of the stoma or adjacent to the stoma. This occurs when the abdominal wall defect (surgically created to allow the intestine to be brought out to the abdominal wall as an ostomy) continues to stretch and enlarge. As a result, the larger defect allows other portions of intestines to sneak into the abdominal wall next to the stoma.
Several factors increase the risk of parastomal hernia including obesity, diabetes, chronic obstructive airway disease (COPD), emergency surgery, perioperative steroid use, and malignancy.
Asymptomatic parastomal hernia does not mandate repair, as the risks of incarceration, obstruction, and strangulation are low. Mild discomfort should be treated with abdominal support and girdles. Surgery is indicated for incarceration, obstruction, strangulation, chronic pain or leakage.
If you are experiencing any of these ostomy complications, Dr. Zaghiyan recommends contacting the surgeon who performed your ostomy operation. For an evaluation and treatment recommendations by Dr. Zaghiyan, call to make an appointment for a consultation in her office in Los Angeles.