Intestinal Stomas—Postoperative Stoma Care and Peristomal Skin Complications

Abstract

Intestinal stomas are necessary for several colon and rectal conditions and represent a major change in the new ostomate's daily life. Though dehydration is the most frequent etiology requiring readmission, irritant contact dermatitis and a host of other peristomal skin conditions are more common complications for ostomates. Wound, ostomy, and continence nurses are invaluable resources to both ostomy patients and providers. A few simple interventions can prevent or resolve most common peristomal complications. Good stoma care is possible in a resource-poor environment.

Ostomy-Related Complications

“…Peristomal skin complications in aggregate occur with a reported incidence of up to 43%, and they are more commonly seen in patients with ileostomies. 15 Frequently, they can be managed with the involvement of clinical ostomy nurse specialists and conservative measures such as utilization of skin barrier rings to adjust the pouching system to improve the appliance seal, topical therapy to protect the skin and promote healing, as well as utilization of convex appliances to enhance stomal protrusion and improve the seal. Thus, these problems are not always brought to the attention of the surgeon and therefore may be underreported.…”

“…Larger or circumferential dehiscence may require operative revision to prevent longer term complications such as retraction or stenosis. 10,15 It is important to note that in certain clinical scenarios, such as in the morbidly obese patient or when anatomic bowel factors mandate, suboptimal stomal construction may be unavoidable. As long as the stoma remains viable above the fascial level, definitive management of stomal complications must come secondary to clinical stability and should be delayed as long as possible to allow for bowel lengthening which may afford the opportunity for successful revision.…”

“…While peristomal skin complications are the most common complication for new ostomates, dehydration from highvolume output is the most common cause of readmission in the early postoperative period, with readmission rates reaching 17% for dehydration alone. 15 proctectomy with an ileal pouch due to the more proximal location of the stoma in the ileum. Readmission for dehydration is associated with later, longer, and repeated readmission.…”

Complicações de estomia intestinal e pele periestoma: evidências para o cuidado de enfermagem [Complications of ostomy bowel and peristomal skin: evidence for nursing care] [Complicaciones de la ostomía intestinal y de la piel peristoma: evidencia para el cuidado de enfermeira]

“…O cuidado e educação adequada às pessoas com estomia são importantes para que elas se sintam confiantes em se cuidar. Além disso, o acompanhamento é fundamental, tanto para a educação no que se refere à identificação precoce de complicações de pele periestoma, quanto para o seu tratamento correto 39 .…”

Stoma Revision on the Flaps in Cases of Abdominal Wall Defect with Digestive Tract Rupture

“…Ileostomy effluent, with an alkaline pH and containing active digestive enzymes, is discharged almost continuously and excoriates and digests unprotected skin if left exposed. A colostomy discharges feces, which can cause continuous contamination of wounds [12]. Many of these patients have lost substantial soft tissue to resurface the wound, due to prior enterectomy resulting in reduced compliance of the skin and abdominal wall caused by multiple operations, stomas, abscesses, and enterocutaneous fistulae [13].…”