Pathophysiology and prevention of loop stomal prolapse in the transverse colon

Abstract

We investigated both pathogenesis and prevention of loop transverse stomal prolapse. Seven patients with reducible prolapsed stoma were studied under fluoroscopy after staining the prolapsed stoma and the colon by barium medium while prolapsing or reducing the stoma with or without the stomal wall pressed on to the abdominal wall of fascial plane. All prolapses occurred in the distal limbs of the loop stoma with the distal transverse colons redundant. The prolapse started around the mucocutaneous suture with the stoma inflated and the colon in it depressed and proceeded in accordance with an addition of abdominal pressure, but did not occur by pressing of the stomal wall. Prolapse of transverse loop stoma occurs when redundant colon invades the stoma with an abdominal pressure. Stomal prolapse might be prevented by fixation of the colon to the fascia.

Stomal prolapse in children with chronic intestinal pseudoobstruction: a frequent complication?

“…Another important factor is increased intraabdominal pressure [17,18]. However, in our study, we failed to demonstrate any link with increased intraabdominal pressure, including patients with megacystis.…”

The modified Altemeier procedure for a loop colostomy prolapse

“…Furthermore, Maeda et al [16] reported that all prolapses occurred in the distal limbs of the loop colostomy; the distal transverse colons were redundant in their study. They suggested that adding abdominal pressure to both of the prolapsing colonic walls from the serosal side induces stomal prolapse in the redundant distal colon.…”

A study comparing split with loop transverse colostomies for defunctioning the left colon

“…Factors critical to this phenomeon include increased mobility of the transverse colon as well as shrinkage of the previously dilated distal colon, both of which have been related to an increased incidence of prolapse associated with LTC. Recently, Maeda et al [14] found that all the prolapses associated with LTC involved the distal limb. Prolapse occurs when redundant colon invades the stoma with increased abdominal pressure.…”

“…Prolapse occurs when redundant colon invades the stoma with increased abdominal pressure. Maeda et al [14] concluded that stomal prolapse might be prevented by fixation of the colon to the fascia.…”