Ileostomy Reversal: Understanding Causes, Treatment Options, and Additional Information
Ileostomy Prolapse: Understanding a Complication of Intestinal Diversion Surgery
An ileostomy prolapse is a common complication that can occur after an ileostomy, a surgical procedure that creates an opening in the abdominal wall for the end of the small intestine (ileum) to be brought out as a stoma. This condition arises when the bowel protrudes excessively through the stoma, often due to a loose fixation between the intestinal tube and the abdominal wall or repeated increases in intra-abdominal pressure.
Causes and Risk Factors
Common causes of ileostomy prolapse include loose or inadequate surgical fixation of the bowel at the stoma site and activities or conditions that cause increased abdominal pressure, such as coughing or heavy lifting. Other risk factors include chronic obstructive lung disease, obesity, advanced age, a redundant intestine, weakness of the abdominal fascia, and an increase in abdominal pressure.
Symptoms
The symptoms of ileostomy prolapse can vary from mild cases that only affect appearance and ease of care to severe prolapse leading to stoma edema, ischemia, and potential irreducible prolapse with associated pain and discoloration. Signs like a purplish or black stoma coloration indicate ischemia and require urgent attention. Other symptoms include possible obstruction symptoms if the prolapsed segment causes blockage.
Treatment
Treatment options for ileostomy prolapse range from conservative management to surgical intervention. Mild prolapse without ischemia may be managed through careful stoma care and observation. However, prompt medical assessment is necessary if there is pain, discoloration, or signs of ischemia or obstruction. In cases of significant ischemia, necrosis, or irreducible prolapse, surgical intervention may be required to resect damaged bowel, reconstruct the stoma, or improve fixation.
Prevention includes surgical techniques ensuring tight fixation and avoiding activities that increase abdominal pressure early in recovery. In some cases, a surgeon may place a sleeve or stent into the stoma, or perform a stoma relocation or revision.
Additional Complications
Although not directly related to prolapse, other complications associated with ileostomy include dehydration and electrolyte imbalances due to loss of colon function and high output through the ileostomy. These require careful monitoring and fluid replacement.
In summary, ileostomy prolapse is primarily caused by loose fixation or pressure causing bowel eversion. Symptoms range from mere protrusion to signs of ischemia, and treatment ranges from conservative care to surgery depending on severity. If you or someone you know experiences unusual stoma protrusion, skin irritation around the stoma, difficulty fitting appliances, bleeding, open wounds called ulcerations, or discomfort around the stoma, it is essential to seek medical attention promptly.
