What Are the Complications of Ostomy Surgery?
What is ostomy surgery of the bowel?
Ostomy surgery of the bowel, also known as bowel diversion, refers to surgical procedures that reroute the normal movement of intestinal contents out of the body when part of the bowel is diseased or removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that waste exits through the abdominal wall instead of passing through the anus.
Ostomy surgery of the bowel may be temporary or permanent, depending on the reason for the surgery. A surgeon specially trained in intestinal surgery performs the procedure in a hospital. During the surgery, the person receives general anesthesia.
Ostomy surgeries of the bowel include:
- Ileoanal reservoir
- Continent ileostomy
What are the complications of ostomy surgery of the bowel?
Complications of ostomy surgery of the bowel may include:
- Skin irritation
- Stoma problems
- Electrolyte imbalance
- Irritation of the internal pouch, or pouchitis
- Vitamin B12 deficiency
- Phantom rectum
- Short bowel syndrome
- Rectal discharge
Skin irritation is the most common complication for people with an ostomy. If the external ostomy pouch does not fit properly, stool or stool contents can leak out around the stoma and under the pouch. When irritated, a person’s skin will become itchy, red, and uncomfortable. When changing the pouch, a person can use an ostomy powder on the skin around the stoma to treat skin irritation.
If the skin irritation does not improve, the person should talk with a wound, ostomy, and continence (WOC) nurse or an enterostomal therapist — who are specially trained in ostomy care and rehabilitation — or another health care provider about the symptoms. Skin irritation may occur around the stoma for people who have an ileostomy or a colostomy. People who have ileoanal reservoir surgery may have skin irritation around the anus. Sometimes, using a barrier ointment to protect the skin around the anus can help treat and prevent irritation.
Stoma problems include the following:
A stoma hernia, seen as a bulge in the skin around the stoma, is a weakening of the abdominal wall around the stoma site. As with all hernias, a stoma hernia continues to increase in size and may eventually need surgical repair when it becomes too large. Rarely, the intestine gets trapped or kinked within the hernia and becomes blocked. A blocked intestine that loses its blood supply requires emergency surgery.
A stoma prolapse occurs when the bowel pushes itself through the stoma. A person may be able to push the bowel back through the stoma and keep it in place with a stoma shield. If not, the stoma prolapse may require special care and a larger ostomy pouch. A stoma prolapse that becomes blocked or loses its blood supply requires surgical repair.
Narrowing of the stoma
Narrowing of the stoma makes it difficult for stool to pass through the stoma. A narrowed stoma may need surgical repair.
Occasionally, an ileostomy or a colostomy does not function for a short time. If the stoma has not passed intestinal content or stool for 4 to 6 hours and the person is experiencing cramping or nausea, the ileum or colon may be blocked. Blockage may occur when foods that are hard to digest get stuck in the ileum or colon.
Abdominal adhesions in the ileum or colon may cause blockage as well. Abdominal adhesions are bands of fibrous tissue that form between abdominal tissues and organs, causing them to kink or narrow. Most blockages get better without additional surgery by not eating food and drinking only clear liquids to rest the bowel for a short time.
Diarrhea is loose, watery stools. A person has diarrhea if he or she passes loose stools three or more times a day. Diarrhea occurs when intestinal contents pass through the small intestine too quickly for fluid and mineral absorption. When fluids and minerals such as sodium and potassium are not absorbed, they leave the body. Diarrhea can lead to dehydration, malnutrition, and weight loss. Diarrhea is common, even normal, with an ileostomy or ileoanal reservoir. In most cases of diarrhea, the only treatment necessary is replacing lost fluids and electrolytes to prevent dehydration.
Electrolytes are minerals in body fluids that are part of salts, including sodium, potassium, magnesium, and chloride. People should maintain good daily hydration by drinking plenty of water and liquids, such as fruit juices, sports drinks, caffeine-free soft drinks, and broths. In some cases of diarrhea, a health care provider may recommend changes in diet and may prescribe medications to treat diarrhea.
As with any major surgery, ostomy surgery may cause internal bleeding. If too much blood is lost, the person may require a blood transfusion. Bleeding may also occur through the stoma or through the anus after surgery.
The main function of the large intestine is to absorb water, nutrients, and electrolytes from partially digested food that enters from the ileum. When a surgeon removes the large intestine, absorption of electrolytes does not occur to the same extent, making electrolyte imbalance more likely. Diarrhea, excessive sweating, and vomiting can increase the chance of developing electrolyte imbalance. Symptoms of electrolyte imbalance may include:
- Fatigue, or feeling tired
- Muscle problems such as spasms, weakness, uncontrolled twitching, and cramps
- Dizziness and confusion
People with these symptoms require medical care and should contact a health care provider.
People who have had their large intestine removed should talk with a health care provider or dietitian about diets that help maintain electrolyte balance.
The GI tract is filled with bacteria that can leak out during ostomy surgery and infect areas inside the abdomen. Bacteria entering the body through the stoma or anus can also cause an infection. The person’s skin around the stoma may also become infected with bacteria or skin fungus. Health care providers treat infections with antibiotics. Symptoms of infection may include:
- Back pain
- Poor appetite
- Nausea and vomiting
Irritation of the Internal Pouch, or Pouchitis
Pouchitis is an irritation or inflammation of the lining of an ileoanal reservoir or a continent ileostomy pouch. A health care provider treats pouchitis with antibiotics. For severe or chronic pouchitis, a health care provider may prescribe immunosuppressive medications, such as corticosteroids. Symptoms of pouchitis include:
- Frequent bowel movements with diarrhea
- An urgent need to have a bowel movement
- A feeling of pressure in the pouch
- Abdominal pain
- Cramping or bleeding
- Low-grade fever
- A general unwell feeling
Vitamin B12 Deficiency
Ostomy surgery of the bowel may affect vitamin B12 absorption from food and result in a gradual drop in vitamin B12 levels in the body. Low levels of vitamin B12 can affect the body’s ability to use nutrients and may cause anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen. Health care providers treat vitamin B12 deficiency with vitamin B12 supplements.
Phantom rectum is the feeling of needing to have a bowel movement even though the rectum is not present. Phantom rectum is relatively common. Symptoms are usually mild and often go away without treatment. However, for some people, phantom rectum may occur for years after a surgeon removes the rectum. Some people with phantom rectum may feel pain.
Health care providers treat rectal pain with medications such as pain relievers and sometimes antidepressants. To help control phantom rectum, a health care provider may recommend complementary therapies such as guided imagery and other relaxation techniques.
Short Bowel Syndrome
Short bowel syndrome is a group of problems related to inadequate absorption of nutrients after removal of part of the small intestine. People with short bowel syndrome cannot absorb enough water, vitamins, and other nutrients from food to sustain life. Diarrhea is the main symptom of short bowel syndrome. Other symptoms may include:
- Weakness and fatigue
- Excessive gas
- Foul-smelling stool
Short bowel syndrome is uncommon and can occur with Crohn’s disease, trauma, or other conditions that lead to removal of a large amount of the small intestine.
A health care provider will recommend a treatment for short bowel syndrome based on a person’s nutritional needs. Treatment may include nutritional support, medications, and surgery.
People with an ileostomy or a colostomy whose lower colon, rectum, and anus are still present may experience a discharge of mucus from their rectum. Mucus is a clear fluid made by the GI tract that coats and protects the lining of the bowel.
Mucus within the bypassed part of the colon may leak out of the rectum from time to time or gradually build up, forming a small, stool-like ball that passes out of the rectum. A person cannot control mucus production and rectal discharge. However, people who have rectal discharge can learn how to manage and cope with this problem.
Seek Immediate Care
People should seek immediate medical care if they have any of the following symptoms, as complications of ostomy surgery can become a medical emergency:
- Continuous nausea and vomiting
- Dramatic change in stoma size, shape, or color
- Continuous bleeding at the junction between the stoma and the skin that does not stop by applying pressure
- Obstruction, prolapse, or narrowing of the stoma
- A deep cut in the stoma
- No output of intestinal content or stool from the stoma for 4 to 6 hours, with cramping and nausea
- Severe diarrhea with risk of dehydration
- Excessive bleeding from the stoma opening
Source: National Institute of Diabetes and Digestive and Kidney Diseases