Complications of bowel stoma

Early complications

• Mucosal sloughing or necrosis of the terminal bowel due to ischaemia.
  Rx = Reoperation and refashioning.
  
  
• Obstruction of stoma due to oedema/faecal impaction/adhesions.
  Rx = Exploration with a gloved finger and sometimes glycerol suppositories or softening enemas.
  
  
• Persistent leak between skin and appliance causing skin erosion and patient distress, often due to inappropriate location of stoma (e.g. over skin crease).
  Rx = May respond to stoma nursing care or require a resiting operation.
  
  
• Haemorrhage at stoma site.
  
  
• Stoma ischaemia - colour progresses from dusky grey to black.
  
  
• High output - can lead to hypokalaemia. Consider loperamide +/- codeine to thicken the output.
  

Late complications

• Obstruction (failure at operation to close the lateral space around stoma).
  
  
• Parastomal hernia due to abdominal wall weakness. Risk increases with time.
  Rx = Resiting.
  
  
• Prolapse of bowel.
  Rx = refashioning.
  
  
• Parastomal fistula.
  Rx = refashioning.
  
  
• Retraction of spout ileostomy
  Rx = refashioning.
  
  
• Stenosis of stomal orifice.
  Rx = refashioning.
  
  
• Perforation after colonic irrigation.
  Rx = emergency operation.
  
  
• Dermatitis around stoma site (worse with ileostomy).
  
  
• Psychological and psychosexual dysfunction.
  Rx = Counselling or measures to reverse stoma.