When a stoma prolapses, bowel telescopes out on itself, lengthening the stoma. A stoma of the ileum may prolapse in 3% to 11% of patients over a lifetime. Causes of stomal prolapse include stomal construction difficulties, abdominal wall abnormalities such as obesity, increased intra-abdominal pressure, and weak abdominal musculature. Clinical findings of stomal prolapse include increase in size and length of the stoma; edema of the mucosa; and bleeding; and if ischemic, it may be dusky, cyanotic, or purple in color.
Management and Disposition
Emergent surgical consultation should occur in patients with a gangrenous stoma or if the prolapse is not reducible. To reduce a prolapsed stoma, have the patient lie supine or in slight Trendelenburg to decrease intra-abdominal pressure. Apply continuous gentle pressure on the prolapsed stomal tissues, into the abdominal cavity. If the bowel is edematous, a cold compress or osmotic therapy using table sugar applied for 15 minutes before reduction attempt may reduce the edema. If stomal prolapse reduction is successful, general surgery follow-up should be arranged as soon as possible.
Oral or intravenous diazepam may help facilitate prolapse reduction.
Your hospital stoma nurse may be a great resource to assist with management of stoma complications.
Application of table sugar to the prolapsed ileum may facilitate reduction by reducing mucosal edema.
Prolapsed Stoma. A 32-year-old man with inflammatory bowel disease and ileostomy presents with a prolapsed stoma. Note the bleeding, edema, and dusky appearance of the ileal mucosa. (Photo contributor: Lawrence B. Stack, MD.)
Prolapsed Stoma. A 48-year-old man with pain and bleeding from stoma that was placed after a partial colectomy for complex diverticulitis. The bowel appears dusky and is oozing blood. (Photo contributor: Nakul Shekhawat, MD, MPH.)