Stomal Prolapse

Stomal Prolapse

Duncan G. Hartley, MD

Table of Contents

Definition
Risk Factors
Complications
Management

See Also:
*See Ostomy

Definition

Stomal Prolapse: Telescoping of the Intestinal End Out of the Stoma

Incidence: 2-26%

Often Associated with a Parastomal Hernia (~ 10-20%)

Stomal Prolapse 1

Risk Factors

Most Common After: Loop Transverse Colostomy

Patient Factors

  • Obesity
  • Poor Muscle Tone
  • Chronic Cough (COPD, Smoking)
  • Chronic Constipation
  • Advanced Age
  • Ascites

Surgical Factors

  • Placement Outside of Rectus Muscle
  • Oversized Fascial Opening
  • Redundant Bowel Proximal to the Stoma
  • Mobile Bowel with Long Mesentery
  • Excessive Splitting/Stretching of Muscle

Complications

Can Interfere with Pouch Appliance Adherence and Cause Leakage with Peristomal Wound Issues

Prolapsed Stoma is More Susceptible to Abrasion, Trauma, Bleeding, and Infection

Risk for Bowel Obstruction Causing Abdominal Pain, Distention, Nausea, and Vomiting

Risk for Bowel Incarceration and Strangulation

Management

Consider Elective Reversal/Takedown if Feasible

Reducible Uncomplicated Prolapse is Managed Conservatively

  • Manual Reduction
  • Appliance Optimization – Use of Larger Pouching Systems or Convex Barriers May Be Appropriate
  • Ostomy/Stoma Belt (Support Binder) Can Help Reduce Traction
  • Avoid Activities that Increase Intraabdominal Pressure (Heavy Lifting/Straining)
  • Diet Modification and Laxative/Stool Softener Use to Prevent Constipation

Adjuncts to Assist in Manual Reduction:

  • Cool Compress
  • Lying Supine with Knees Slightly Flexed
  • Analgesia and Anxiolysis to Relax the Abdominal Wall
  • Application of Sugar – Osmotic Agent to Draw Out Water and Decrease Edema

Surgical Revision

  • Emergent Surgical Revision Required for Incarceration/Strangulation
  • Consider Elective Surgical Revision for High-Grade Symptoms that Fail to Respond to Conservative Management and Restrict Activities of Daily Living
    • Difficulty in Stoma Care
    • Severe Pain
    • Stomal Injury due to Appliance
  • Generally Done by Local Revision – Full-Thickness Resection of the Prolapsed Segment with Reconstruction of the Ostomy at the Same Site

References

  1. Bhange SA, Gala AP, Sathe SM, Bhansali MS. Intussusception through an ileostomy. South Asian J Cancer. 2013 Jul;2(3):150. (License: CC BY-NC-SA-3.0)