By Brown, Jennings
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Entrapment of bowel through the lateral gutter of the abdominal cavity, in the peritoneum or through the pelvic–peritoneal closure line after abdominoperineal resection of the rectum should be considered as a possible cause of intestinal obstruction. Bolus obstruction of an otherwise healthy ileostomy due to consumption of bulky, indigestible foods (notably fruit pith and nuts) is common. Retroperitoneal tunneling of ileostomy or colostomy (which was advocated in the past in order to avoid entrapment of the bowel in the lateral space) is especially likely to result in mechanical obstruction and has long since been abandoned for this reason.
Fligelstone LJ, Wanandeya N, Palmer BV. Osmotic therapy for acute irreducible stoma prolapse. Br J Surg 1997; 84: 390–1. Hata F, Kitagawa S, Nishimori H, et al. A novel, easy and safe technique to repair a stoma prolapse using a surgical stapling device. Dig Surg 2005; 22: 306–10. Chang SC, Shen MH, Lee HHC. Local repair for a loop colostomy using a linear stapling device. J Soc Colon Rectal Surgeon 2008; 1: 22–6. Potter KL. Surgical oncology of the pelvis: ostomy planning and management. J Surg Oncol 2000; 73: 237–42.
The patient with a fecal stoma may complain of constipation followed by a large volume of output. With stenosis at the fascial level, the stoma may be normal in appearance but the patient may present with symptoms of incomplete intestinal obstruction. Management Management of stenosis depends on its level of severity. Mild stenosis with minimal signs and symptoms will respond to a low residue diet, stool softeners, and adequate hydration, which will facilitate the movement of soft stool through the bowel lumen.