Crohn’s Disease-Related Stoma Complications and Their Impact on Postsurgical Course

Abstract

Introduction: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. The diversion through a colostomy or an ileostomy is sometimes required for disease control. In these patients, common stoma-related complications sum up with CD-related complications and often require revisional surgery. Methods: The aim of the study was to assess stoma morbidity after surgery for CD and to identify the burden of CD-related complications. Details of past medical history, surgery and follow up of 54 consecutive patients operated on for CD with any sort of stoma were retrieved from the stoma therapist prospectively maintained database. Results: In our series, 23 patients had a colostomy, and 31 an ileostomy. CD-related complications arose in 8 patients (including pyoderma gangrenosus in 3 patients, peristomal fistulae in 2, granulomas in 2, and peristomal abscess in 1). Patients with CD-related complications had shorter disease duration (p=0.07) and, more frequently end-stoma (p=0.006). In this cohort, 11 cases had to be surgically treated for peristomal fistulae or abscess, parastomal hernia, prolapse, pyoderma gangrenosus and recurrent CD. Discussion/conclusions: In patients with CD, stoma creation is burdened by a high rate of postoperative complication and a relevant rate is specifically related to CD. Often these patients required to be re-operated on to re-do the stoma. Moreover, end stoma configuration and aggressive CD phenotype are associated to a higher rate of complications.

The Management of Postoperative Recurrence in Crohn’s Disease

“…The team should consist of gastroenterologists, surgeons, radiologists, and rheumatologists and dermatologists, when necessary, who collaboratively assess the patient’s risk profile and determine the most appropriate treatment. In addition, the involvement of a stoma therapist, navigator nurse, nutritionist, psychologist, and even clinical pharmacist is paramount in the comprehensive management of patients, providing support and guidance throughout the treatment process [ 138 , 139 , 140 , 141 , 142 ]. By involving a multidisciplinary team, the management of POR in CD can be tailored to the specific needs of each patient, taking into consideration risk factors and individualized therapeutic strategies.…”

Stoma and peristomal complications: a rapid overview of the literature

“…Because the etiology has not been determined, the diagnosis is based on careful proximal and remote pathologic history, in addition to the objective examination, as well as observation of the lesion, the outcome of the histopathologic examination, and the exclusion of other diseases that may present a similar clinical pattern. Data in the literature show that this complication has an incidence ranging from 0.3% to 8% 3,53,55 .…”

Management of a Peristomal Abscess in a Patient With an Ileostomy

“…2,3 Peristomal abscess (PA) is a less prevalent but no less challenging complication. 4,5 Patients with colorectal cancer are especially at risk owing to treatment with chemotherapy or radiotherapy that may compromise mucosal integrity and impair the body's immune functions. Once ileostomy effluent causes peristomal skin breakdown, skin ulceration and infection can occur resulting in PA. 6 Treatment of PA may include an initial incision and drainage of the abscess, resulting in a wound in the peristomal area and an increased risk for perisomal irritant contact dermatitis pain.…”

“…Associated peristomal skin breakdown is a prevalent complication attributed to the corrosive proteolytic enzymes of ileostomy effluent 2,3. Peristomal abscess (PA) is a less prevalent but no less challenging complication 4,5. Patients with colorectal cancer are especially at risk owing to treatment with chemotherapy or radiotherapy that may compromise mucosal integrity and impair the body's immune functions.…”