Stoma Prolapse

Abstract

Stoma prolapse after formation of an ileostomy or colostomy is a late complication. Prolapse is less common than parastomal hernia. This article reviews the incidence of prolapse, technical factors related to the construction of the stoma that may influence the incidence, and different options for repair. Stoma prolapse affects 2%-47% of individuals with ostomies. Transverse loop colostomy has the highest rate of stoma prolapse, especially because of the large redundant distal loop. Loop ileostomies were thought to have a higher prevalence rate in the past, but recent literature shows only a 2% prolapse rate for ileostomy as opposed to 47% for loop colostomy. The role of extraperitoneal stoma construction is uncertain. Fascial fixation and size of the fascial defect have not been proven to affect the incidence of prolapse. Local care of stoma prolapse is possible, especially if stoma is not incarcerated; however, reversal of stoma is preferable if possible. The options of surgical repair include reversal, resection, revision, and relocation. Semin Colon Rectal Surg 23:13-16 © 2012 Elsevier Inc. All rights reserved. D espite substantial advances in surgical technique and enterostomal therapy, complications after stoma creation remain extremely common. The rate of stoma-specific complications in the literature varies widely, ranging from 10% to 70%. 1-5 Stoma complications can be divided into early and late complications. Of the late complications, parastomal hernias are more common than stoma prolapse. Predisposing factors for development of stomal prolapse can be identified as patient factors, technique, and location of ostomy. This review describes the incidence of prolapse and assesses the technical factors related to the construction of the stoma that may influence this incidence. The different methods of repair have also been outlined.

Management of Stoma Prolapse: A Novel Technique for Repair

“…However, in some cases reversal may not be a possibility and would require an alternative approach which includes surgical techniques like resection, revision or relocation [8]. Expectant management can sometimes be adopted in cases where timing is the only issue preventing reversal of stoma [9]. During this time conservative measures like belt application, stoma sizing, manual reduction, application of sugar or icing to reduce incarcerated stoma and skin care with application of lubricants like petroleum jelly etc.…”

Prolapse of intestinal stoma

“…However, another report showed that the incidence of stoma prolapse was 11.8% in end colostomy [11,24], whereas the incidence of loop ileostomy prolapse reached 11% during long-term follow-up at the same institution [13]. Stoma prolapse often involves the distal side of a loop stoma [4,22,[24][25][26][27][28].…”

Strangulated stoma prolapse: surgical treatment conserving proximal ileostomy

“…It is caused by an oversized opening in the abdominal wall, increased intra‐abdominal pressure and weakened abdominal musculature 2 …”

“…1 It is caused by an oversized opening in the abdominal wall, increased intra-abdominal pressure and weakened abdominal musculature. 2 The aim of this study is to report the first case in the literature of strangulated small bowel hernia within a prolapsed stoma in which we retained the old proximal limb of the ileostomy and made up a colostomy with the distal limb after performing an ileo caecal resection.…”