Lawton-Fort Sill Ostomy Association

Attachment #2

STOMA COMPLICATIONS

From: North Texas Ostomy News Via: Sherman Area Ostomy Assoc. and Evansville, Indiana Chapter Re-Route

Many pathological conditions can necessitate the need for some type of bowel or urinary diversion known as an ostomy. For the most part, ostomies are well managed by the patient, and/or caregiver. Sometimes complications can occur. A list of basic stoma complications follows:

Necrosis-A dark, black stoma due to inadequate blood supply. This can be caused by excessive tension on the mesentery, too thick of an abdominal wall for the intestines to pass through, too tight a suture line, or interruption of blood flow (clot). Management is based on the extent of necrosis. Superficially-- continual monitoring: it may slough off and can be managed with a modified pouching system. If it is below the fascia level, it often requires stoma reconstruction.

Detachment - The stoma separates completely from the adjoining skin. This is caused by too much tension on the mesentery and requires surgical revision of the stoma.

Recession-Retraction - Sinking of the stoma below the skin level. This can be caused by scar formation secondary to mucocutaneous separation, necrosis, peristomal skin problems, weight gain, radiation, recurrent malignancies, or excessive tension on the suture line. This can be medically managed with a modified pouching system. Severe cases may require stoma revision.

Stenosis-Strictures-- Extreme narrowing of the stoma that can threaten the normal function of stool evacuation. Multiple causes can include inadequate suturing at the fascia level, mucocutaneous separation, edema, and disease conditions which may cause scar formation that compress the stoma causing ribbon-like stool or obstruction. This may be medically managed with stoma dilation or require surgical intervention.

Prolapse - Telescoping of the bowel out through the stoma. Poor abdominal wall support and increased abdominal pressure from coughing, sneezing, laughing, or tumor formation are common risk factors. Conservative management of a prolapse includes reduction of protrusion by gentle pressure, cool wash cloth and even sugar (acts as an osmotic diuretic) on the stoma, then applying a binder or prolapse belt. In some cases, prolapse is medically managed if the patient is considered a surgical risk.

Hernia - Protrusion of the bowel into the subcutaneous tissue around the stoma. This is characterized by a bulge in the abdominal wall or tension on the abdominal wall or on the abdominal muscle. This is medically managed by wearing a binder and/or modified pouching system. If herniation leads to a blockage, surgical intervention is required. To aid in prevention of a hernia, wear a binder especially when lifting heavy objects, or guarding the stoma with a hand pillow when coughing or laughing. One noted entertainer places a hand over his side, guarding the stoma when laughing.

Obstruction - Blockage of a stoma from recurrent disease process, or twisting-kinking of a loop of bowel in the abdomen. Surgical intervention is required.

Impaction - (In colostomates). Stoma clogged by hard stool requiring stool softening with enema or a small amount of oil prior to stoma irrigation. Impaction may be prevented by drinking 8 to 10 glasses of fluid per day, attention to diet and regular use of stool softeners.

Safe to swim here?

While fishing off the Florida coast, a Yankee tourist capsized his boat. He could swim, but his fear of alligators kept him clinging to the overturned craft. Spotting an old guy standing on the shore, the Yankee shouted, "Are there any gators around here?!"

"Naw," the man hollered back, "they ain't been around for years!" Feeling safe, the tourist started swimming leisurely toward the shore. About halfway there he asked the guy, "How'd you get rid of the gators?" "We didn't do nothin'," the old guy said. "The sharks got 'em."

Business and fishing

One day a southerner was lying on a beautiful beach, with his fishing pole propped up in the sand and his solitary line cast out into the sparkling blue surf. He was enjoying the warmth of the afternoon sun and the prospect of catching a fish.

About that time, a Yankee businessman came walking down the beach, trying to relieve some of the stress of his workday. He noticed the fisherman sitting on the beach and decided to find out why this fisherman was fishing instead of working harder to make a living for himself and his family.

"You aren't going to catch many fish that way," said the Yankee businessman to the fisherman, "you should be working rather than lying on the beach!"

The fisherman looked up at the businessman, smiled and replied, "And what would my reward be?"

"Well, you can get bigger nets and catch more fish!" was the Yankee's answer.

"And then what will my reward be?" asked the fisherman, still smiling.

The businessman replied, "You'll make money and you'll be able to buy a boat, which will then result in larger catches of fish!"

"And then what will my reward be?" asked the fisherman again.

The Yankee businessman was beginning to get a little irritated with the fisherman's questions. "You can buy a bigger boat, and hire some people to work for you!" he said.

"And then what will my reward be?" repeated the fisherman.

The businessman was getting angry. "Don't you understand? You can build up a fleet of fishing boats, sail all over the world, and let all your employees catch fish for you!"

Once again the fisherman asked, "And then what will my reward be?"

The businessman was red with rage and shouted at the fisherman, "Don't you understand that you can become so rich that you'll never have to work for your living again! You can spend all the rest of your days sitting on this beach, looking at the sunset, without a care in the world!"

The fisherman looked up at the poor Yankee and smiled.

A Hunting Incident

Have you heard about the poor hunter whose wife and mother-in -law insisted he take them on a hunting trip? It seems he finally gave in. One evening, after yet another uneventful hunt, he called it a day and started towards the camp, intending to collect the women from their stands on the way back.

As his wife was climbing down from her stand, they heard his mother-in-law scream. Rushing towards the sound, they rounded a clearing and came upon a chilling sight: the mother-in-law was backed up against a tree and a large bear stood facing her.

"Darling," the wife cried, "what are we going to do?"

"Be still..." said the husband. "That bear got himself into this mess, let him get himself out of it!"

Attachment #3