Preventing And Treating The Most Common Colostomy Complications
An anastomosis between the colon and the abdominal skin is known as a colostomy. A colostomy can be permanent or temporary, depending on why you need it. Two types of colostomies include a loop colostomy and an end colostomy.
The more distal the colon, the more firm will be the stomal output. Conversely, a stoma in a part of the colon nearer to the small bowel will produce more liquid stool, which is going to have a strong foul smell.
During the preoperative setting, it can be quite fruitful to send the patient for consultation with an enterostomal therapist. During this consultation, the nurse will mark the site of the stoma, and the healthcare provider will teach the patient the basics of ostomy care. The marking of the stoma must be at the place of the rectus muscle. More importantly, this part of the skin shouldn’t have any creases, or it will make the stoma care harder.
Colostomy complications
Complications can occur in 10-60% of patients with colostomies. Most of these are technical complications that can occur during the first month of surgery. Complications that can occur during the first few months after surgery include edema, stoma retraction, necrosis, parastomal evisceration, hemorrhagic complications, obstruction, and peristomal infections.
Complications that might occur a few months after surgery include stenosis, parastomal hernia, prolapse, and stoma perforation.
Early Complications
The most common early complications of colostomy are edema and necrosis. These can result from primary ischemia or secondary ischemia. The primary ischemia refers to an excessive de-vascularization of the mesocolon. The secondary ischemia occurs due to the excessive traction of the colon.
The consistent transition of the traction results in the stoma converting into edema. Necrosis can appear when the traction and constriction remain maintained. These complications generally result in the patient needing to undergo a re-intervention, which involves the reconstruction of the colostomy.
Cases of stoma retraction occur in 2-3% of people with colostomies. Risk factors for this complication may include obesity, postoperative ileus, and the presence of infection at the site of surgery before the surgical procedure.
The occurrence of these complications necessitates the patient to undergo a quick evaluation. A prompt re-intervention will prevent the issue from worsening.
Obstruction can also occur in people with colostomies. It can develop in the small or large intestine. An obstruction mostly occurs as a result of a loop of intestine incarcerated at the parietal orifice. A re-intervention may be necessary for patients with intestinal obstructions.
Late complications
Prolapse is the most common complication that can occur a few months after surgery. The stoma prolapse happens with the colon mucosa or the total length of the wall. It can happen in the end or loop colostomies. This complication results from a difference between the skin incision and parietal orifice.
Another one of the most common colostomy complications is the peristomal hernia. It can complicate a colostomy significantly. Fortunately, it doesn’t require re-intervention in most of the cases.
A surgeon should keep these complications and their risk factors into consideration while creating a colostomy.
