Stomal prolapse > 의학

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Stomal prolapse — Prolapse is the telescoping of the intestine out from the stoma and can occur with any type of stoma. Prolapse can make appliance placement and adherence difficult, and prolonged prolapse causes intestinal edema and, if significant, can lead to intestinal incarceration or strangulation.

The incidence ranges from 7 to 26 percent, with the highest rates associated with a loop transverse colostomy and end descending colostomies [29,34,49,55,56]. Risk factors for prolapse may include a large abdominal trephine, increased intra-abdominal pressure, and a redundant loop of bowel proximal to the stoma [35]. Alternative fixation techniques during ostomy construction have been proposed to prevent prolapse [32,40,57,58]. However, there are no data to support these approaches. (See "Overview of surgical ostomy for fecal diversion", section on 'Other sites of fixation'.)

Uncomplicated prolapse can be managed conservatively with cool compresses and/or application of an osmotic agent (eg, table sugar or honey) to reduce edema, followed by manual reduction of the prolapse and application of a binder with a prolapse over-belt to keep the bowel recued into the abdomen, or by pouching modifications to accommodate the prolapsed bowel when reduction cannot be established or maintained [7,51,59]. Manual reduction should be initiated at the very tip of the prolapse (beehive) or lumen, and then gentle, slow invagination should proceed. In this way, the prolapsed bowel will intussuscept back into the abdomen.

Complicated prolapse or 

prolapse producing ischemic changes or 

severe mucosal irritation and bleeding

 usually requires surgical intervention. Local revision of the prolapse is accomplished by performing a full-thickness resection of the prolapsed intestinal segment with construction of the stoma at the original site. In the event of a further recurrence, additional bowel resection and relocation of the stoma may be necessary [35].