Before a new stoma bag is applied, the skin should be cleaned and dried carefully. If the skin is wet, erosive, and inflamed, early involvement of a stoma nurse is extremely important to ensure appropriate care and follow-up. In the emergency department, a visual inspection of the ostomy bag is important to ensure that it is properly fitted. Patients may present with itching and excoriations or a sore on the skin as a result of irritant contact dermatitis or even with bacterial or fungal infections. A variety of peristomal skin problems ranging from mild dermatitis to severe ulcerations can be encountered. Risk factors include obesity, diabetes and leakage due to a large aperture in the flange or a skin crease. Because the absorptive capacity of the colon is being bypassed, patients with an ileostomy have a watery output with a highly alkaline and active enzymatic content that can be extremely toxic and irritative to the skin. This is the most frequently observed complication with all stoma types. This article will provide a review of emergencies and complications associated with ileostomies, colostomies, and urostomies.įull size table Early complications Skin irritationĭespite advancements in ostomy procedures as well as improvements with ostomy systems, patients continue to experience irritation of the skin surrounding the ostomy (Fig. Accordingly, emergency physicians should be familiar with the types of stomas and the complications and emergencies associated with them, so that they can appropriately address them. Emergency physicians are not expected to be stoma experts, yet they are often the first point of contact for patients experiencing stoma-related complications. Nonetheless, complications are prevalent, despite advancements in the formation and care of ostomies. In the USA, roughly 150,000 people undergo a creation of either a colostomy or an ileostomy annually. The United Ostomy Association estimates that slightly more than 500,000 Americans now have some type of stoma. Stoma creation can be done in either an elective surgery or emergency setting. Stomas can be created in the gastrointestinal tract (colostomies and ileostomies) and in the urogenital tract (urostomies) as either temporary or permanent solutions for redirecting stool or urine content. The term “stoma” comes from the Greek word meaning “mouth” and is interchangeably used with “ostomy.” A stoma is a surgical opening between a hollow organ and the body surface that is created when an anastomosis is not possible, either due to high risk of failure or when there is nothing distally to attach to.
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