Stoma-related complications and emergencies

Abstract

Stoma creations are common procedures in surgical specialties. They can be created either as a temporary or a permanent measure. Despite advancements in surgical technique and stoma care, complications are common. Patients experiencing stoma-related complications often present to the emergency department. Emergency physicians are not expected to be stoma experts, yet they are often the first point of contact for patients experiencing stoma-related complications. Accordingly, emergency physicians should be familiar with the types of stomas and complications and emergencies associated with them so that they can appropriately address the problems related to stomas. This article will provide a review of emergencies and complications associated with ileostomies, colostomies, and urostomies.

Keywords: Colostomy; High-output stoma; Ileostomy; Ostomy; Parastomal herniation; Stoma; Stoma care; Stoma complications; Stoma necrosis; Stoma obstruction; Urostomy.

Fig. 1

Loop ileostomy. A loop of the small intestine is pulled out through an abdominal incision and sutured to the skin. This type of stoma has two openings, which connect to the ascending and descending segment of the bowel

Fig. 2

Hartmann pouch. Colostomies are preferably placed in the left abdomen. There are two types of colostomies: end colostomies and loop end colostomies. In end colostomies, a rectal stump is being left behind, known as Hartmann’s pouch

Fig. 3

Peristomal skin irritation. Peristomal skin irritation is a commonly observed complication in all stoma types, which is related to the enzymatically active content of the output

Fig. 4

Non-continent cutaneous urinary diversion. Urine is drained from the ureters to a conduit, constructed from the ileum or the colon, and anastomosed to the abdominal skin surface, where the urine is collected into an external appliance

Fig. 5

Continent cutaneous urinary diversion. The ureters are attached to a urinary pouch, created from a bowel segment (ileum or colon), which then is brought to the skin as a stoma

Fig. 6

Continent orthotopic diversion. A section of the bowel is used to reconstruct the bladder, which then allows the use of the native urethral sphincter