Complication

Description

Prevention and Management

Bleeding

Bleeding or hemorrhage may be caused by portal hypertension, trauma, abrasion, improper pouch fit, and other conditions (eg pyodermin, malignancy, polyps)

Rule out causes that can be removed (shaving too hard, rubbing stoma); report to physician for further diagnosis

Caput medusae

Bluish-purple discoloration around ostomy caused by dilation of veins; occurs in patients with portal hypertension

Avoid irritation of skin around stoma; use flexible face plates; minimize use of adhesives

Chemical breakdown

Breakdown of peristomal skin from contact with stool or adhesive solvents

Adjust pouching system to prevent leaking; clean skin after use of adhesive solvents, use stoma powder as needed to absorb excess moisture; use stoma paste as needed to fill folds/creases to prevent stool leakage; thin flexible wafer use may protect irritated area

Fluid and electrolyte imbalance

Caused by excessive loss of fluids and related to dehydration

Prevention includes adequate fluid intake, avoidance of laxatives; rehydration may be required

Mechanical breakdown

Breakdown of peristomal skin from frequent removal of wafer/pouching system, adhesives, cleansers, and adhesive solvents

Re-education of patient on when pouching systems need to be removed and replaced; use of absorbent stoma powder, and/or non-alcohol skin sealant

Melanosis coli

Black or dark brown skin related to abuse of anthracene agents, such as cascara

Counsel and reduce abuse

Mucocutaneous separation

Separation of stoma from skin, which narrows the ostomy or leads to stenosis; may be more common in malnutrition or treatment with steroids

Reduce risk for malnutrition through counseling patients on eating adequately; consider vitamin A supplementation to reduce steroid effect on healing

Partial bowel obstruction

Symptoms include abdominal cramps, nausea/vomiting, diarrhea (possibly explosive), excessive flatus

Report immediately; may require surgical intervention

Peristomal hernia

Bulge around stoma that can lead to abdominal pain, ischemic bowel, and bowel obstruction

Use flexible pouches, lie down to minimize hernia; hernia belts or binders can minimize problems until surgical correction can be completed

Prolapse

Seen in patients who are overweight or have weak abdominal muscles;

Cold compresses, better pouch fit (flat or flexible pouching system), prevent pinching of bowel; consider abdominal support belt with prolapse overbelt; instruct patients to be in supine position when applying pouch; report any abdominal pain or ischemia immediately

Pseudoverrucous lesions

White-grey or red-brown and wart-like discolorations at mucocutaneous border of stoma; caused by prolonged exposure of skin to moisture.

Change pouch more frequently, use skin barrier film or paste that resists breakdown; use convexity in some cases; surgical removal may be required

Pyoderma gangrenosum

Erythematic and irregular shaped red-purple lesions that may be indurated (localized hardening of soft tissue) or ulcerated (being eroded away); the base may enlarge and produce purulent drainage; an inflammatory skin disease that may be related to immune diseases (ulcerative colitis, Crohn’s)

Adequate seal may require absorptive powders/pastes; disease management is important to support healing and may include steroid treatment

Stenosis

Narrowing of stoma; due to inadequate suturing, mucocutaneous separation; can be caused by Crohn’s, cancer, long-term irrigation

Surgical correction is required

Stomal necrosis

Black areas and/or stoma due to tension on mesentery, melanosis coli, or embolus

Report immediately; risk for peritonitis and perforation