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Clin Colon Rectal Surg 2002; 15(3): 199-208
DOI: 10.1055/s-2002-34088
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Late Stomal Complications

Malcolm CA Steel, James S. Wu
  • Department of Colon and Rectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH.
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Publication History

Publication Date:
20 September 2002 (online)

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ABSTRACT

Stoma complications occurring after the initial rehabilitation of the patient have a major impact on stoma function and the patient's quality of life. Timely assessment and management is crucial in minimizing morbidity, as well as containing community and hospital costs. This article describes late stoma complications and reviews the current literature to propose appropriate management strategies.

KEYWORDS

Stoma - complications - colostomy - ileostomy

REFERENCES

  • 1 Londono-Schimmer E E, Leong A P, Phillips R K. Life-table analysis of stomal complications following colostomy.  Dis Colon Rectum . 1994;  37 916-20
    CrossrefPubMedGoogle Scholar
  • 2 Park J J, Del Pino A, Orsay C P. Stoma complications: the Cook County Hospital experience.  Dis Colon Rectum . 1999;  42(12) 1575-1580
    CrossrefPubMedGoogle Scholar
  • 3 Pearl R K, Prasad M L, Orsay C P, Abcarian H, Tan A B, Melzl M T. Early local complications from intestinal stomas.  Arch Surg . 1985;  120 1145-1147
    PubMedGoogle Scholar
  • 4 Porter J A, Salvati E P, Rubin R J, Eisenstat T E. Complications of colostomies.  Dis Colon Rectum . 1989;  32(4) 299-303
    CrossrefPubMedGoogle Scholar
  • 5 Fleshman J W, Lewis M G. Complications and quality of life after stoma surgery: a review of 16,470 patients in the UOA data registry.  Semin Colon Rectal Surg . 1991;  2 66-72
    PubMedGoogle Scholar
  • 6 Leong A PK, Londono-Schimmer E E, Phillips R KS. Life-table analysis of stomal complications following ileostomy.  Br J Surg . 1994;  81 727-729
    CrossrefPubMedGoogle Scholar
  • 7 Goligher J. Surgery of the anus, rectum, and colon.  5th ed. London: Baillier Tindall 1985
    Google Scholar
  • 8 Pearl R K. Parastomal hernias.  World J Surg . 1989;  13 569-572
    CrossrefPubMedGoogle Scholar
  • 9 Martin L, Foster G. Peristomal hernia.  Annals of the Royal College of Surgeons of England . 1996;  78(2) 81-84
    PubMedGoogle Scholar
  • 10 Williams J G, Etherington R, Hayward M W, Hughes L E. Paraileostomy hernia: a clinical and radiological study.  Br J Surg . 1990;  77(12) 1355-1357
    CrossrefPubMedGoogle Scholar
  • 11 Rubin M S, Schoetz Jr J D, Matthews J B. Parastomal hernia. Is stoma relocation superior to fascial repair?.  Arch Surg . 1994;  129(4) 413-419
    CrossrefPubMedGoogle Scholar
  • 12 Leenen L P, Kuypers J H. Some factors influencing the outcome of stoma surgery.  Dis Colon Rectum . 1989;  32(6) 500-504
    CrossrefPubMedGoogle Scholar
  • 13 Carlstedt A, Fasth S, Hulten L, Nordgren S, Palselius I. Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease.  Int J Colorectal Dis . 1987;  2(1) 22-25
    CrossrefPubMedGoogle Scholar
  • 14 Cheung M T, Chia N H, Chiu W Y. Surgical treatment of peristomal hernia complicating sigmoid colostomies.  Dis Colon Rectum . 2001;  44(2) 266-270
    CrossrefPubMedGoogle Scholar
  • 15 Sjodahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma.  Br J Surg . 1988;  75(4) 339-41
    CrossrefPubMedGoogle Scholar
  • 16 Ludwig K A, Milsom J W, Garcia-Ruiz A, Fazio V W. Laparoscopic techniques for fecal diversion.  Dis Colon Rectum . 1996;  39 285-288
    PubMedGoogle Scholar
  • 17 Turnbull R B. Intestinal stomas.  Surg Clin N Am . 1958;  38 1361-1372
    PubMedGoogle Scholar
  • 18 Leslie D. The peristomal hernia.  Surg Clin N Am . 1984;  64(2) 407-415
    PubMedGoogle Scholar
  • 19 Goligher J. Extraperitoneal colostomy or ileostomy.  Br J Surg . 1958;  46 97
    CrossrefPubMedGoogle Scholar
  • 20 Whittaker M, Goligher J C. A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies.  Dis Colon Rectum . 1976;  19 342-344
    CrossrefPubMedGoogle Scholar
  • 21 Marks C G, Ritchie J K. The complications of synchronous combined excision for adenocarcinoma of the rectum at St. Marks hospital.  Br J Surg . 1975;  62 901-905
    PubMedGoogle Scholar
  • 22 Etherington R J, Williams J G, Hayward M W, Hughes L E. Demonstration of para-ileostomy herniation using computed tomography.  Clinic Radiol . 1990;  41(5) 333-336
    PubMedGoogle Scholar
  • 23 Allen-Mersh T G, Thomson J P. Surgical treatment of colostomy complications.  Br J Surg . 1988;  75(5) 416-418
    CrossrefPubMedGoogle Scholar
  • 24 Thorlakson R. Technique of repair of herniations associated with colonic stomas.  Surg Gynecol Obstet . 1965;  120 347-350
    PubMedGoogle Scholar
  • 25 Taylor R L, Rombeau J L, Turnbull R B. Transperitoneal relocation of the ileal stoma without formal laparotomy.  Surg Gynecol Obstet . 1978;  146(6) 953-958
    PubMedGoogle Scholar
  • 26 Kaufman J J. Repair of peristomal hernia by translocation of the stoma without laparotomy.  J Urol . 1983;  129(2) 278-279
    PubMedGoogle Scholar
  • 27 Botet X, Boldo E, Llaurado J M. Colonic peristomal hernia repair by translocation without formal laparotomy.  Br J Surg . 1996;  83(7) 981
    PubMedGoogle Scholar
  • 28 Morris-Stiff G J, Hughes L E. The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience.  J Am Coll Surg . 1998;  186(3) 352-367
    CrossrefPubMedGoogle Scholar
  • 29 Moisidis E, Curiskis J I, Brooke-Cowden G L. Improving the reinforcement of peristomal tissues with Marlex mesh: laboratory study identifying solutions to stomal aperture distortion.  Dis Colon Rectum . 2000;  43(1) 55-60
    CrossrefPubMedGoogle Scholar
  • 30 Tekkis P P, Kocher H M, Payne J G. Peristomal hernia repair: modified Thorlakson technique, reinforced by polypropylene mesh.  Dis Colon Rectum . 1999;  42(11) 1505-1508
    CrossrefPubMedGoogle Scholar
  • 31 Sugarbaker P H. Peritoneal approach to prosthetic mesh repair of periostomy hernias.  Ann Surg . 1985;  201(3) 344-346
    CrossrefPubMedGoogle Scholar
  • 32 Voitk A. Simple technique for laparoscopic paracolostomy hernia repair.  Dis Colon Rectum . 2000;  43(10) 1451-1453
    PubMedGoogle Scholar
  • 33 Kasperk R, Klinge U, Schumpelick V. The repair of large peristomal hernias using a midline approach and a prosthetic mesh in the sublay position.  Am J Surg . 2000;  179(3) 186-188
    CrossrefPubMedGoogle Scholar
  • 34 Shellito P C. Complications of abdominal stoma surgery.  Dis Colon Rectum . 1998;  41(12) 1562-1572
    CrossrefPubMedGoogle Scholar
  • 35 Speakman C T, Parker M C, Northover J M. Outcome of stapled revision of retracted ileostomy.  Br J Surg . 1991;  78(8) 935-936
    PubMedGoogle Scholar
  • 36 Turnbull R J. Management of the ileostomy.  Am J Surg . 1953;  86 617-624
    CrossrefPubMedGoogle Scholar
  • 37 Truedson H, Press V. A new method of stomal reconstruction in patients with retraction of conventional ileostomy.  Surg Gynecol Obstet . 1986;  162(1) 60-61
    PubMedGoogle Scholar
  • 38 Ecker K W, Schmid T, Xu H S, Feifel G. Improved stabilization of conventional (Brooke) ileostomies with the stapler technique.  World J Surg . 1992;  16(3) 525-529
    PubMedGoogle Scholar
  • 39 Winslet M C, Alexander-Williams J, Keighley M R. Ileostomy revision with a GIA stapler under intravenous sedation.  Br J Surg . 1990;  77(6) 647
    PubMedGoogle Scholar
  • 40 Turnbull R B, Fazio V W. Advances in the surgical technique of ulcerative colitis surgery. Endoanal proctectomy and two-directional myotomy ileostomy In: L N, ed. Surg Ann, New York: Appleton-Century-Crofts 1975: 315-329
    Google Scholar
  • 41 Pemberton J H. Management of conventional ileostomies.  World J Surg . 1988;  12(2) 203-210
    CrossrefPubMedGoogle Scholar
  • 42 Warren J, McKittrick L. Ileostomy for ulcerative colitis.  Surg Gynecol Obstet . 1951;  93 555-567
    PubMedGoogle Scholar
  • 43 Gorfine SR BJ, Gelernt I M. Continent stomas. In: MacKeigan JM CP, ed. Intestinal stomas. Principles, techniques, and management St. Louis: Quality Medical Publishing 1993 : 154-187
    Google Scholar
  • 44 Edwards D P, Leppington-Clarke A, Sexton R, Heald R J, Moran B J. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial.  Br J Surg . 2001;  88(3) 360-363
    CrossrefPubMedGoogle Scholar
  • 45 Arun H, Ledgerwood A, Lucas C E. Ostomy prolapse in paraplegic patients: etiology, prevention, and treatment.  J Am Paraplegia Soc . 1990;  13(2) 7-9
    PubMedGoogle Scholar
  • 46 Chandler J G, Evans B P. Colostomy prolapse.  Surg . 1978;  84(5) 577-582
    PubMedGoogle Scholar
  • 47 Last M, Fazio V, Lavery I, Jagelman D. Conservative management of para-ileostomy ulcers in patients with Crohn's disease.  Dis Colon Rectum . 1984;  27(12) 779-786
    PubMedGoogle Scholar
  • 48 Greenstein A J, Dicker A, Meyers S, Aufses Jr H A. Peri-ileostomy fistulae in Crohn's disease.  Ann Surg . 1983;  197(2) 179-182
    PubMedGoogle Scholar
  • 49 Targan S R, Hanauer S B, van Deventer J S, Mayer L, Present D H, Braakman T. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Disease cA2 Study Group.  New Eng J Med . 1997;  337(15) 1029-1035
    CrossrefPubMedGoogle Scholar
  • 50 Present D H, Rutgeerts P, Targan S, Hanauer S B, Mayer L, van Hogezand A R. Infliximab for the treatment of fistulas in patients with Crohn's disease.  N Eng J Med . 1999;  340(18) 1398-1405
    CrossrefPubMedGoogle Scholar
  • 51 Schoetz Jr J D, Coller J A, Veidenheimer M C. Pyoderma gangrenosum and Crohn's disease. Eight cases and a review of the literature.  Dis Colon Rectum . 1983;  26(3) 155-158
    PubMedGoogle Scholar
  • 52 Cairns B A, Herbst C A, Sartor B R, Briggaman R A, Koruda M J. Peristomal pyoderma gangrenosum and inflammatory bowel disease.  Arch Surg . 1994;  129(7) 769-772
    PubMedGoogle Scholar
  • 53 Tjandra J J, Hughes L E. Parastomal pyoderma gangrenosum in inflammatory bowel disease.  Dis Colon Rectum . 1994;  37(9) 938-942
    CrossrefPubMedGoogle Scholar
  • 54 Keltz M, Lebwohl M, Bishop S. Peristomal pyoderma gangrenosum.  J Am Acad Derm . 1992;  27(2 Pt 2) 360-364
    PubMedGoogle Scholar
  • 55 Grundfest-Broniatowski S, Fazio V. Conservative treatment of bleeding stomal varices.  Arch Surg . 1983;  118(8) 981-985
    PubMedGoogle Scholar
  • 56 Morris C S, Najarian K E. Transjugular intrahepatic portosystemic shunt for bleeding stomal varices associated with chronic portal vein occlusion: long-term angiographic, hemodynamic, and clinical follow-up.  Am J Gast . 2000;  95(10) 2966-2968
    PubMedGoogle Scholar
  • 57 Shibata D, Brophy D P, Gordon F D, Anastopoulos H T, Sentovich S M, Bleday R. Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension.  Dis Colon Rectum . 1999;  42(12) 1581-1585
    CrossrefPubMedGoogle Scholar
  • 58 Beck D E, Fazio V W, Grundfest-Broniatowski S. Surgical management of bleeding stomal varices.  Dis Colon Rectum . 1988;  31(5) 343-346
    PubMedGoogle Scholar
  • 59 Suarez V, Alexander-Williams J, O'Connor H J, Campos A, Fuggle W J, Thompson H. Carcinoma developing in ileostomies after 25 or more years.  Gast . 1988;  95(1) 205-208
    PubMedGoogle Scholar
  • 60 Carne P, Farmer K. Squamous-cell carcinoma developing in an ileostomy stoma: report of a case.  Dis Colon Rectum . 2001;  44(4) 594
    PubMedGoogle Scholar
  • 61 Gadacz T R, McFadden D W, Gabrielson E W, Ullah A, Berman J J. Adenocarcinoma of the ileostomy: the latent risk of cancer after colectomy for ulcerative colitis and familial polyposis.  Surg . 1990;  107(6) 698-703
    PubMedGoogle Scholar
  • 62 Todd I. Mechanical complications of ileostomy.  Clinic Gastroenterol . 1982;  11 268-273
    PubMedGoogle Scholar