Understanding Colostomy
Understanding Colostomy Surgery
Colostomy Types: Locations and Care Needs
Colostomy is one of the most commonly performed surgical procedures, often serving as a crucial means to save lives, prolong survival, and enhance the quality of life. Although colostomy helps patients through critical times, various complications related to colostomy and its surrounding areas can lead to significant distress for patients and even pose life-threatening risks. Research indicates that the incidence of colostomy complications in Western countries ranges from 11% to 70%. In the U.S., studies have shown that among patients undergoing colostomy, approximately 30% experience complications that can impact their recovery and overall quality of life. Therefore, actively preventing and treating colostomy and its associated complications is of utmost importance.
I. Colostomy Complications
(A) Stoma Edema
Stoma edema commonly occurs in the early postoperative period, typically between 2 to 5 days after surgery. It manifests as swelling of the stoma mucosa and a feeling of tightness around the stoma. This condition generally does not require special treatment and usually resolves within a week. If the edema worsens, applying saline wet dressings or stoma care powder can be beneficial.
(B) Stoma Bleeding
Stoma bleeding typically occurs within 72 hours post-surgery. Most often, it results from bleeding from capillaries and small veins at the junction of the stoma mucosa and skin, and the amount is usually minimal.
Management includes:
- Check for the cause of bleeding.
- If due to mucosal friction, apply stoma care powder and gently press with soft tissue or gauze to stop the bleeding. Advise the patient to use soft tissues when cleaning the stoma.
- Minor oozing can be managed by applying slight pressure with gauze.
- For significant bleeding, use gauze soaked in a diluted adrenaline solution for compression, or apply hemostatic powder, then compress with gauze.
- Severe bleeding should be promptly reported to a doctor.
(C) Ischemia and Necrosis
Ischemia and necrosis of the stoma is one of the most serious early complications of colostomy surgery, often occurring within 24 to 48 hours after the procedure. The stoma may appear partially or completely cyanotic. With timely treatment, ischemic stoma tissue can recover, but continued deterioration can lead to tissue necrosis. If the stoma becomes entirely black and necrotic, timely stoma reconstruction surgery is necessary.
Management includes:
- Assessing the vitality of the stoma. If viable intestinal mucosa is visible, clean the stoma and apply stoma care powder regularly. If significant necrosis is found, inform the doctor for surgical intervention.
- If fluid accumulates under the stoma mucosa, partially remove stitches to drain the fluid and trim away necrotic tissue if necessary.
(D) Mucosal Separation
Mucosal separation refers to the separation of the stoma mucosa from the abdominal wall skin at the suture site. This commonly occurs in the early postoperative period, often secondary to stoma bleeding and ischemia/necrosis.
Management involves:
- Assessing the depth of separation and performing debridement of necrotic tissue.
- For shallow separation, apply stoma care powder. For deeper separations, consider specialized dressings for drainage and apply barrier paste to seal gaps.
- Stoma bag selection: For shallow separations, use a two-piece stoma bag; for deeper separations, choose a convex base plate and a belt for compression.
(E) Retraction
Retraction refers to the stoma's inward collapse below the skin surface, which can occur early or late after colostomy surgery. Early retraction is often due to inadequate stoma fixation or tension, while late retraction typically occurs secondary to stoma necrosis or separation. Studies indicate that approximately 1% to 6% of colostomies experience retraction. This can lead to leakage and increased nursing difficulty.
Management includes:
- Monitor early postoperative mild retraction; for severe cases, surgical intervention may be necessary.
- Use a convex base plate and belt to help protrude the stoma and apply skin protectants for any damage.
- Advise weight loss for excessively obese patients.
(F) Stenosis
Stenosis refers to the narrowing of the stoma, a common complication that can occur early or late after surgery. It often results from stoma ischemia or necrosis. Stenosis occurs in 2% to 10% of ileostomies and single-lumen colostomies.
Management includes:
- For mild stenosis, gently widen the stoma using fingers or dilators, taking care not to cause further damage. Surgical reconstruction may be necessary for more severe cases.
- Monitor for constipation in cases of descending colon or sigmoid colostomy stenosis, and provide dietary advice accordingly.
(G) Prolapse
Prolapse refers to the protrusion of the intestinal segment through the stoma, which can vary in length. This condition may lead to various complications such as edema, bleeding, and ischemic necrosis. Long-term observations indicate that about 12% of transverse colostomies and 11% of ileostomies experience prolapse. Stoma prolapse can significantly inconvenience daily life for patients.
Management includes:
- Mild prolapse typically requires no special treatment. Advise patients to avoid increasing abdominal pressure and to manage their stoma care carefully.
- Instruct patients on accurately measuring the stoma size and correctly adhering the stoma bag.
II. Summary
Complications following colostomy surgery can lead to significant suffering for patients. Therefore, stoma care professionals must actively monitor the stoma and provide appropriate treatment strategies to ensure patient recovery. With proper nursing interventions and timely resolutions of complications, stoma-related issues can be effectively managed, minimizing patient suffering.
As we move forward, it’s essential to understand not only the complications that may arise but also the pathways available for resolution. The next article will delve into colostomy reversal, exploring the processes, expectations, and outcomes for patients seeking this surgical option.