Ver el código de «Ostomy complications»

==Background==
*Ostomies (colostomy, ileostomy, urostomy) are common, and patients frequently present to the ED with complications<ref>Parini D, et al. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg. 2023 Oct 10;18(1):48. PMID 37817218</ref>
*Types: colostomy (most common), ileostomy (higher output, more dehydration risk), urostomy
*Key EM pearl: ileostomy patients are at high risk for '''dehydration and electrolyte derangements''' due to high-volume liquid output<ref>Babakhanlou R, et al. Stoma-related complications and emergencies. Int J Emerg Med. 2022 May 9;15(1):17. PMID 35534817</ref>

==Complications==

===Parastomal Hernia===
*Most common long-term complication
*Bulge around stoma that may reduce spontaneously
*If reducible and nontender: outpatient surgery referral
*If incarcerated/strangulated: nausea, vomiting, non-functioning stoma → emergent surgical consultation

===Stomal Prolapse===
*Telescoping of bowel through stoma — can appear dramatic but is often reducible
*Apply sugar to edematous stoma to reduce swelling, then gently reduce
*Surgical consultation if unable to reduce or if signs of ischemia (dusky/black color)

===Stomal Retraction/Stenosis===
*Stoma retracts below skin level or narrows
*Difficult appliance management, obstruction risk
*Surgical referral for revision

===Obstruction===
*High-output stoma that suddenly stops functioning
*Abdominal distension, nausea/vomiting, cramping
*Abdominal X-ray or CT to evaluate
*Management similar to [[small bowel obstruction]]: NPO, NG tube, IV fluids
*Surgical consultation

===Peristomal Skin Breakdown===
*Irritant contact dermatitis from effluent exposure (especially ileostomy — alkaline output)
*Candidal infection (satellite lesions)
*Allergic contact dermatitis (from appliance adhesive)
*Management: barrier creams/powders, proper appliance fitting, treat infection

===Stomal Ischemia/Necrosis===
*Stoma appears dark, dusky, or black
*If only superficial: observation with close follow-up
*If necrosis extends below fascia: emergent surgical consultation (risk of peritonitis)

===Dehydration / Electrolyte Derangements===
*Especially with '''ileostomies''' — can lose 1-2L/day
*High output: >1.5 L/day warrants evaluation
*Risk of hyponatremia, hypokalemia, metabolic acidosis, AKI
*Aggressive IV fluid resuscitation, electrolyte replacement

===Bleeding===
*Minor stomal bleeding (trauma from appliance): direct pressure, silver nitrate
*GI bleeding through stoma: evaluate as any GI bleed — CBC, type and screen, GI consultation

===Infection===
*Peristomal cellulitis or abscess
*Antibiotics; I&D if abscess present

==Evaluation==
*Stomal assessment: color (should be pink/red), output, surrounding skin
*[[BMP]]: electrolytes, renal function (especially ileostomy patients)
*[[CBC]] if concern for bleeding or infection
*Abdominal X-ray or CT if obstruction or peritonitis suspected
*Stool studies if infectious diarrhea suspected (high-output colostomy)

==Disposition==
*Admit: obstruction, stomal necrosis below fascia, incarcerated hernia, significant dehydration/AKI, GI bleeding
*Discharge: reducible prolapse, minor skin breakdown, mild dehydration corrected in ED, minor bleeding
*Ostomy nurse referral for appliance issues and skin management

==See Also==
*[[Post-surgical complications]]
*[[Small bowel obstruction]]
*[[G-tube complications]]

==External Links==

==References==
<references/>

[[Category:GI]]
[[Category:Surgery]]