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Clin Colon Rectal Surg 2017; 30(03): 184-192
DOI: 10.1055/s-0037-1598159
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intestinal Stomas—Postoperative Stoma Care and Peristomal Skin Complications

Emily Steinhagen
1   Division of Colon and Rectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
,
Janice Colwell
2   Section of Colon and Rectal Surgery, Department of General Surgery, University of Chicago Medicine, Chicago, Illinois
,
Lisa M. Cannon
2   Section of Colon and Rectal Surgery, Department of General Surgery, University of Chicago Medicine, Chicago, Illinois
› Author Affiliations
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Publication History

Publication Date:
22 May 2017 (online)

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Abstract

Intestinal stomas are necessary for several colon and rectal conditions and represent a major change in the new ostomate's daily life. Though dehydration is the most frequent etiology requiring readmission, irritant contact dermatitis and a host of other peristomal skin conditions are more common complications for ostomates. Wound, ostomy, and continence nurses are invaluable resources to both ostomy patients and providers. A few simple interventions can prevent or resolve most common peristomal complications. Good stoma care is possible in a resource-poor environment.

Keywords

ileostomy - colostomy - peristomal skin complications - enterostomal therapy - ostomy
 

  • References

  • 1 Hignett S, Parmar CD, Lewis W, Makin CA, Walsh CJ. Ileostomy formation does not prolong hospital length of stay after open anterior resection when performed within an enhanced recovery programme. Colorectal Dis 2011; 13 (10) 1180-1183
    CrossrefPubMedGoogle Scholar
  • 2 Tang CL, Yunos A, Leong AP, Seow-Choen F, Goh HS. Ileostomy output in the early postoperative period. Br J Surg 1995; 82 (05) 607
    CrossrefPubMedGoogle Scholar
  • 3 Taylor WE. PJH. Stoma physiology. In: MacKeigan JM, Cataldo PA. , eds. Intestinal Stomas: Principles, Techniques, and Management. St. Louis, MO: Quality Medical Publishing; 2004
    Google Scholar
  • 4 Hill GL, Goligher JC, Smith AH, Mair WS. Long term changes in total body water, total exchangable sodium and total body potassium before and after ileostomy. Br J Surg 1975; 62 (07) 524-527
    CrossrefPubMedGoogle Scholar
  • 5 Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum 2013; 56 (08) 974-979
    CrossrefPubMedGoogle Scholar
  • 6 Messaris E, Sehgal R, Deiling S. , et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 2012; 55 (02) 175-180
    CrossrefPubMedGoogle Scholar
  • 7 Prinz A, Colwell JC, Cross HH, Mantel J, Perkins J, Walker CA. Discharge planning for a patient with a new ostomy: best practice for clinicians. J Wound Ostomy Continence Nurs 2015; 42 (01) 79-82
    CrossrefPubMedGoogle Scholar
  • 8 Hendren S, Hammond K, Glasgow SC. , et al. Clinical practice guidelines for ostomy surgery. Dis Colon Rectum 2015; 58 (04) 375-387
    CrossrefPubMedGoogle Scholar
  • 9 Nichols TR. Social connectivity in those 24 months or less postsurgery. J Wound Ostomy Continence Nurs 2011; 38 (01) 63-68
    CrossrefPubMedGoogle Scholar
  • 10 Coggrave MJ, Ingram RM, Gardner BP, Norton CS. The impact of stoma for bowel management after spinal cord injury. Spinal Cord 2012; 50 (11) 848-852
    CrossrefPubMedGoogle Scholar
  • 11 Salvadalena G. Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. J Wound Ostomy Continence Nurs 2008; 35 (06) 596-607 , quiz 608–609
    CrossrefPubMedGoogle Scholar
  • 12 Erwin-Toth P, Thompson SJ, Davis JS. Factors impacting the quality of life of people with an ostomy in North America: results from the Dialogue Study. J Wound Ostomy Continence Nurs 2012; 39 (04) 417-422 , quiz 423–424
    CrossrefPubMedGoogle Scholar
  • 13 Wound, Ostomy and Continence Nurses Society. Available at http://www.wocn.org/default.asp?page=Nurse_Referral . Accessed November 11, 2015
    PubMedGoogle Scholar
  • 14 American College of Surgeons. Available at https://www.facs.org/education/patient-education/skills-programs/ostomy-program . Accessed November, 2015
    PubMed
  • 15 Pittman J, Rawl SM, Schmidt CM. , et al. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Continence Nurs 2008; 35 (05) 493-503
    CrossrefPubMedGoogle Scholar
  • 16 Salvadalena G, Hendren S, McKenna L. , et al. WOCN Society and ASCRS Position Statement on preoperative stoma site marking for patients undergoing colostomy or ileostomy surgery. J Wound Ostomy Continence Nurs 2015; 42 (03) 249-252
    CrossrefPubMedGoogle Scholar
  • 17 Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg 2002; 68 (11) 961-966 , discussion 966
    PubMedGoogle Scholar
  • 18 Robertson I, Leung E, Hughes D. , et al. Prospective analysis of stoma-related complications. Colorectal Dis 2005; 7 (03) 279-285
    CrossrefPubMedGoogle Scholar
  • 19 Arumugam PJ, Bevan L, Macdonald L. , et al. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis 2003; 5 (01) 49-52
    CrossrefPubMedGoogle Scholar
  • 20 Chun LJ, Haigh PI, Tam MS, Abbas MA. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum 2012; 55 (02) 167-174
    CrossrefPubMedGoogle Scholar
  • 21 Leong AP, Londono-Schimmer EE, Phillips RK. Life-table analysis of stomal complications following ileostomy. Br J Surg 1994; 81 (05) 727-729
    CrossrefPubMedGoogle Scholar
  • 22 Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37 (09) 916-920
    CrossrefPubMedGoogle Scholar
  • 23 Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis 2007; 9 (06) 559-561
    CrossrefPubMedGoogle Scholar
  • 24 Saghir JH, McKenzie FD, Leckie DM. , et al. Factors that predict complications after construction of a stoma: a retrospective study. Eur J Surg 2001; 167 (07) 531-534
    CrossrefPubMedGoogle Scholar
  • 25 Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum 2003; 46 (11) 1461-1467 , discussion 1467–1468
    CrossrefPubMedGoogle Scholar
  • 26 Takahashi K, Funayama Y, Fukushima K. , et al. Stoma-related complications in inflammatory bowel disease. Dig Surg 2008; 25 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 27 Carlstedt A, Fasth S, Hultén L, Nordgren S, Palselius I. Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease. Int J Colorectal Dis 1987; 2 (01) 22-25
    CrossrefPubMedGoogle Scholar
  • 28 Boyd-Carson W, Thompson MJ, Trainor B, Boyd K. Mucocutaneous separation. Nurs Stand 2004; 18 (17) 41-43
    CrossrefPubMedGoogle Scholar
  • 29 Salvadalena G. Peri-stomal skin conditions. In: Carmel JE, Colwell JC, Goldberg MT. , eds. WOCN Core Curriculum: Ostomy Management. Philadelphia, PA: Wolter Kluwer; 2015
    Google Scholar
  • 30 Agarwal S, Ehrlich A. Stoma dermatitis: prevalent but often overlooked. Dermatitis 2010; 21 (03) 138-147
    PubMedGoogle Scholar
  • 31 Nybaek H, Jemec GB. Skin problems in stoma patients. J Eur Acad Dermatol Venereol 2010; 24 (03) 249-257
    CrossrefPubMedGoogle Scholar
  • 32 Lyon CC, Smith AJ, Griffiths CE, Beck MH. The spectrum of skin disorders in abdominal stoma patients. Br J Dermatol 2000; 143 (06) 1248-1260
    CrossrefPubMedGoogle Scholar
  • 33 Meisner S, Lehur PA, Moran B, Martins L, Jemec GB. Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. PLoS One 2012; 7 (05) e37813
    CrossrefPubMedGoogle Scholar
  • 34 Mahmoud NNBB. Diagnosis and treatment of peristomal skin conditions. In: MacKeigan JM, Cataldo PA. , eds. Intestinal Stomas: Principles, Techniques, and Management. 2nd ed. St Louis, MO: Quality Medical Publishing; 2004: 39-55
    Google Scholar
  • 35 Douri T, Shawaf AZ. Letter: Pseudoverrucous papules and nodules: a case report. Dermatol Online J 2012; 18 (04) 14
    PubMedGoogle Scholar
  • 36 Hellman J, Lago CP. Dermatologic complications in colostomy and ileostomy patients. Int J Dermatol 1990; 29 (02) 129-133
    CrossrefPubMedGoogle Scholar
  • 37 Morales-Mendoza Y, Fernández-Martínez R, Fabián-Victoriano MR. , et al. Candida species isolation in peristomal skin in patients with abdominal stomas and correlation to clinical signs: a descriptive pilot study. Adv Skin Wound Care 2014; 27 (11) 500-504
    CrossrefPubMedGoogle Scholar
  • 38 Maeda C, Hidaka E, Shimada M. , et al. Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report. World J Surg Oncol 2015; 13: 171
    CrossrefPubMedGoogle Scholar
  • 39 Mourra N, Bataillon G, Lesurtel M. Fungating mass occurring at a colostomy site 50 years after colectomy for inflammatory condition. Gastroenterology 2014; 146 (02) e1-e2
    PubMedGoogle Scholar
  • 40 Sabater-Marco V, García-García JA, Roig-Vila JV. Basaloid large cell lung carcinoma presenting as cutaneous metastasis at the colostomy site after abdominoperineal resection for rectal carcinoma. J Cutan Pathol 2013; 40 (08) 758-764
    CrossrefPubMedGoogle Scholar
  • 41 Vijayasekar C, Noormohamed S, Cheetham MJ. Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer. World J Surg Oncol 2008; 6: 96
    CrossrefPubMedGoogle Scholar
  • 42 Shibuya T, Uchiyama K, Kokuma M. , et al. Metachronous adenocarcinoma occurring at a colostomy site after abdominoperineal resection for rectal carcinoma. J Gastroenterol 2002; 37 (05) 387-390
    CrossrefPubMedGoogle Scholar