Overview
This article reviews complications and emergencies associated with surgical stoma creation—including ileostomies, colostomies, and urostomies—with a focus on clinical presentations, management strategies, and emergency department considerations.
Types of Stomas and Indications
- Stomas are surgically created openings to divert stool or urine via the gastrointestinal or urinary tract.
- Ileostomies and colostomies are used for bowel disease, trauma, cancer, or obstruction; urostomies are used for urinary diversion after cystectomy or bladder dysfunction.
- Stomas can be temporary or permanent and may be formed electively or in emergencies.
Stoma-related Complications: Overview
- Complications are prevalent, with rates between 10–70%, and risk persists lifelong.
- Complications are classified as early (postoperative) or late (months to years after surgery).
- Early complications include skin irritation, high output, dehydration, and necrosis; late complications include hernias, prolapse, stenosis, and obstruction.
Early Complications
- Skin irritation is most common, often from leakage or poor appliance fit; risk factors include obesity and diabetes.
- High-output stomas (>1500 ml/day) can cause dehydration and electrolyte imbalances, especially in ileostomies.
- Stoma necrosis is often due to ischemia; mild cases can be monitored, but severe necrosis requires urgent surgical intervention.
Late Complications
- Parastomal hernias (up to 50% incidence) are more common in those with obesity or advanced age and can lead to obstruction or strangulation.
- Stomal prolapse is more frequent with loop stomas and may require surgery if ischemia occurs.
- Stomal stenosis leads to obstruction; diagnosis includes clinical exam and imaging, with urgent surgical consult for complete blockage.
Urostomy-specific Complications
- Early complications (20–57%) include GI issues (ileus, obstruction), infection (bacteriuria, sepsis), and wound problems.
- Late complications involve stomal issues (retraction, stenosis, hernia), metabolic disturbances (vitamin B12 deficiency, bone disease, acidosis), and mechanical strictures.
- Diagnosis and management in the ED require blood tests, imaging, and early consultation with specialists.
Emergency Department Management Strategies
- Visual and clinical assessment of stoma and appliance is essential.
- Bloodwork and imaging are key for assessing dehydration, infection, obstruction, or metabolic disturbances.
- Early involvement of specialized stoma nurses and surgical or urology teams is recommended.
- Prompt correction of fluid, electrolytes, or metabolic derangements and initiation of antibiotics for infection is crucial.
Recommendations / Advice
- Emergency physicians should familiarize themselves with stoma types, complications, and initial management steps.
- Early specialist consultation is advisable for acute or severe presentations.
- Proper appliance fit and patient education reduce incidence of many complications.