Ostomy Complications in Crohn's Disease

Abstract

Ostomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum.

Stoma-related complications and emergencies

“…Common early complications include leakage and skin irritations, high output resulting in fluid and electrolyte imbalances, or stoma necrosis; late complications include parastomal hernia, stoma prolapse, and stoma stenosis [ 7 ]. These can develop as a result of surgical- or patient-related factors (Table 2 ) [ 2 , 10 – 12 ].…”

“…3 ). This is the most frequently observed complication with all stoma types [ 2 , 7 , 12 ]. Because the absorptive capacity of the colon is being bypassed, patients with an ileostomy have a watery output with a highly alkaline and active enzymatic content that can be extremely toxic and irritative to the skin [ 13 ].…”

“…Because the absorptive capacity of the colon is being bypassed, patients with an ileostomy have a watery output with a highly alkaline and active enzymatic content that can be extremely toxic and irritative to the skin [ 13 ]. Risk factors include obesity, diabetes and leakage due to a large aperture in the flange or a skin crease [ 2 , 7 , 13 ]. A variety of peristomal skin problems ranging from mild dermatitis to severe ulcerations can be encountered.…”

“…A variety of peristomal skin problems ranging from mild dermatitis to severe ulcerations can be encountered. Patients may present with itching and excoriations or a sore on the skin as a result of irritant contact dermatitis or even with bacterial or fungal infections [ 2 ]. In the emergency department, a visual inspection of the ostomy bag is important to ensure that it is properly fitted.…”

“…Stomas can be created in the gastrointestinal tract (colostomies and ileostomies) and in the urogenital tract (urostomies) as either temporary or permanent solutions for redirecting stool or urine content. Stoma creation can be done in either an elective surgery or emergency setting [ 2 ]. The United Ostomy Association estimates that slightly more than 500,000 Americans now have some type of stoma [ 3 ].…”