Current Management of Intestinal Stomas and Their Complications

Abstract

Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the "principles of perioperative patient management" section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the "early complications" section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the "late complications" section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre-and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.

Colostomy and Ileostomy Care

“…It is defined as high output stoma when the output is greater than 2 L/day or if the output leads to dehydration. Besides dehydration which can result in frequent hospital readmissions, major electrolyte abnormalities include hyponatremia, hypokalemia, and hypomagnesemia (Tsujinaka et al 2020;Bafford and Irani 2013). Loss of more than 60 to 100 cm of terminal ileum can lead to malabsorption with resulting deficiency of vitamins B12, A, D, E, and K. Appropriate pouching with adequate appliance fit to maintain peristomal skin integrity and fluid and electrolyte balance with vitamin supplementation is needed.…”

“…In most cases it heals with local wound care: use of stomal powder, filling the defect with alginate or gelling fiber, and covering it with a solid hydrocolloid or pouch skin barrier. Local application of antibacterial cream or systemic antibiotics may be indicated if there is evidence of infection (Wound 2018;Tsujinaka et al 2020).…”

“…Stomal ischemia/necrosis is usually due to surgical technique; tension on the mesentery, ligation of the primary blood vessel or excessive division of the peristomal mesentery (Tsujinaka et al 2020). Management depends upon the depth.…”

“…Superficial necrosis can be observed. However, if the necrosis extends below the fascia, then an emergent surgical revision is warranted (Wound 2018;Tsujinaka et al 2020).…”

“…Acute prolapse can be successfully reduced at the bedside by application of sugar to decrease edema of bowel wall. Management usually involves pouching modification and application of an abdominal belt or binder; surgical intervention is warranted if the prolapse is severe enough to produce obstruction or ischemic changes in the bowel (Tsujinaka et al 2020).…”