Prolapse of intestinal stoma

Abstract

Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

Ileostomy: Early and Late Complications

“…Several etiologic factors have been associated with a higher incidence of stomal prolapse, such as obesity, pregnancy, conditions causing elevated abdominal pressure, chronic obstructive lung disease, and large surgical incisions. 7 38 39…”

“…This can be very alarming for the patient, who will need an explanation about what is happening. [37][38][39] Prolapse of the stoma may be intermittent or permanent, and it is often associated with multiple complications, such as parastomal hernia, skin excoriation, bleeding, and stoma management problems. 38 In certain cases, severe strangulation of the protruded stoma will lead to ischemia, requiring emergency surgical treatment.…”

“…Several etiologic factors have been associated with a higher incidence of stomal prolapse, such as obesity, pregnancy, conditions causing elevated abdominal pressure, chronic obstructive lung disease, and large surgical incisions. 7,38,39 Different grades of severity of a prolapse can be identified using a classification well described by Maeda, 39 which defines as grade 1 cases of reducible and asymptomatic prolapse; grade 2 refers to recurrent prolapse after manual reduction; Grade 3 is represented by more serious conditions that affect daily activities and present high-intensity symptoms, such as severe pain and unmanageable stoma; and grade 4 consists in life-threatening situations following a stoma prolapse. This classification can be helpful in terms of the choice of treatment.…”

“…In terms of surgery methods, many techniques can be used to repair the prolapse; however, they should aim at fixing the intestine, shortening the intestine or repairing the stoma outlet. 38,39 Parastomal Hernia Parastomal hernias are incisional hernias formed in the stoma site or directly adjacent to the stoma, where the intra-abdominal organs protrude through the previouslycreated trephine due to constant centrifugal forces. 10,40 Typically, a physical examination is sufficient for the diagnosis of a parastomal hernia, but, in certain cases, a computed tomography (CT) scan or ultrasound are required to obtain a better view.…”

Stoma Complications

“…63 Elective operations to repair stoma prolapse typically address either bowel laxity, bowel length, or the size of the stoma aperture. 64 Local revision, with an incision around the stoma itself, appears to be more common, but less successful than transabdominal repair. 63 Division of the prolapsing segment with a surgical stapler and/or converting a loop stoma to an end stoma by dividing the defunctionalized limb and returning it to the abdominal cavity appears to be both among the most successful and least invasive repair techniques.…”