Ostomy complications - Revision history

Danbot: Add verified PubMed references (PMIDs 37817218, 35534817)

2026-03-22T10:56:59Z

Add verified PubMed references (PMIDs 37817218, 35534817)

← Older revision		Revision as of 10:56, 22 March 2026
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	==Background==		==Background==
	*Ostomies (colostomy, ileostomy, urostomy) are common, and patients frequently present to the ED with complications		*Ostomies (colostomy, ileostomy, urostomy) are common, and patients frequently present to the ED with complications<ref>Parini D, et al. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg. 2023 Oct 10;18(1):48. PMID 37817218</ref>
	*Types: colostomy (most common), ileostomy (higher output, more dehydration risk), urostomy		*Types: colostomy (most common), ileostomy (higher output, more dehydration risk), urostomy
	*Key EM pearl: ileostomy patients are at high risk for '''dehydration and electrolyte derangements''' due to high-volume liquid output		*Key EM pearl: ileostomy patients are at high risk for '''dehydration and electrolyte derangements''' due to high-volume liquid output<ref>Babakhanlou R, et al. Stoma-related complications and emergencies. Int J Emerg Med. 2022 May 9;15(1):17. PMID 35534817</ref>

	==Complications==		==Complications==

Danbot: Expanded with concise EM-focused content: complication types, stomal assessment, ileostomy dehydration risk, management, disposition

2026-03-21T00:33:49Z

Expanded with concise EM-focused content: complication types, stomal assessment, ileostomy dehydration risk, management, disposition

← Older revision		Revision as of 00:33, 21 March 2026
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	~~<languages/>~~
	~~<translate>~~

	==Background==		==Background==
			*Ostomies (colostomy, ileostomy, urostomy) are common, and patients frequently present to the ED with complications
			*Types: colostomy (most common), ileostomy (higher output, more dehydration risk), urostomy
			*Key EM pearl: ileostomy patients are at high risk for '''dehydration and electrolyte derangements''' due to high-volume liquid output

			==Complications==

	==~~Clinical Features~~==		===Parastomal Hernia===
			*Most common long-term complication
			*Bulge around stoma that may reduce spontaneously
			*If reducible and nontender: outpatient surgery referral
			*If incarcerated/strangulated: nausea, vomiting, non-functioning stoma → emergent surgical consultation

			===Stomal Prolapse===
			*Telescoping of bowel through stoma — can appear dramatic but is often reducible
			*Apply sugar to edematous stoma to reduce swelling, then gently reduce
			*Surgical consultation if unable to reduce or if signs of ischemia (dusky/black color)

	==~~Differential Diagnosis~~==		===Stomal Retraction/Stenosis===
			*Stoma retracts below skin level or narrows
			*Difficult appliance management, obstruction risk
			*Surgical referral for revision

			===Obstruction===
			*High-output stoma that suddenly stops functioning
			*Abdominal distension, nausea/vomiting, cramping
			*Abdominal X-ray or CT to evaluate
			*Management similar to [[small bowel obstruction]]: NPO, NG tube, IV fluids
			*Surgical consultation

	==~~Evaluation~~==		===Peristomal Skin Breakdown===
			*Irritant contact dermatitis from effluent exposure (especially ileostomy — alkaline output)
			*Candidal infection (satellite lesions)
			*Allergic contact dermatitis (from appliance adhesive)
			*Management: barrier creams/powders, proper appliance fitting, treat infection

			===Stomal Ischemia/Necrosis===
			*Stoma appears dark, dusky, or black
			*If only superficial: observation with close follow-up
			*If necrosis extends below fascia: emergent surgical consultation (risk of peritonitis)

	===~~Workup~~===		===Dehydration / Electrolyte Derangements===
			*Especially with '''ileostomies''' — can lose 1-2L/day
			*High output: >1.5 L/day warrants evaluation
			*Risk of hyponatremia, hypokalemia, metabolic acidosis, AKI
			*Aggressive IV fluid resuscitation, electrolyte replacement

			===Bleeding===
			*Minor stomal bleeding (trauma from appliance): direct pressure, silver nitrate
			*GI bleeding through stoma: evaluate as any GI bleed — CBC, type and screen, GI consultation

	===~~Diagnosis~~===		===Infection===
			*Peristomal cellulitis or abscess
			*Antibiotics; I&D if abscess present
	~~==Management==~~

			==Evaluation==
			*Stomal assessment: color (should be pink/red), output, surrounding skin
			*[[BMP]]: electrolytes, renal function (especially ileostomy patients)
			*[[CBC]] if concern for bleeding or infection
			*Abdominal X-ray or CT if obstruction or peritonitis suspected
			*Stool studies if infectious diarrhea suspected (high-output colostomy)

	==Disposition==		==Disposition==
			*Admit: obstruction, stomal necrosis below fascia, incarcerated hernia, significant dehydration/AKI, GI bleeding
			*Discharge: reducible prolapse, minor skin breakdown, mild dehydration corrected in ED, minor bleeding
			*Ostomy nurse referral for appliance issues and skin management

	==See Also==		==See Also==
			*[[Post-surgical complications]]
	*[[~~Special:MyLanguage/~~Post-surgical complications~~\|Post~~-~~surgical~~ complications]]		*[[Small bowel obstruction]]
			*[[G-tube complications]]

	==External Links==		==External Links==

	*Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/


	==References==		==References==

	<references/>		<references/>


	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
	~~</translate>~~

Ostermayer: Prepared the page for translation

2026-01-04T23:50:50Z

Prepared the page for translation

← Older revision		Revision as of 23:50, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

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	==Evaluation==		==Evaluation==


	===Workup===		===Workup===


	===Diagnosis===		===Diagnosis===


	==Management==		==Management==
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	==See Also==		==See Also==
	*[[Post-surgical complications]]
			*[[Special:MyLanguage/Post-surgical complications\|Post-surgical complications]]


	==External Links==		==External Links==

	*Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/		*Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/


	==References==		==References==

	<references/>		<references/>

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	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
			</translate>

Rossdonaldson1: /* References */

2021-02-18T17:01:50Z

References

← Older revision		Revision as of 17:01, 18 February 2021
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	==References==		==References==
	<references/>		<references/>


			[[Category:GI]]
			[[Category:Surgery]]

Rossdonaldson1: /* See Also */

2021-02-18T16:59:59Z

Rossdonaldson1 at 16:58, 18 February 2021

2021-02-18T16:58:55Z

← Older revision		Revision as of 16:58, 18 February 2021
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	==== ~~Complications and ED management of colostomy, ileostomy, and urostomy.<ref>~~Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/~~</ref>~~ ====		==Background==


			==Clinical Features==


			==Differential Diagnosis==


			==Evaluation==
			===Workup===

			===Diagnosis===

			==Management==


			==Disposition==


			==See Also==


			==External Links==
			*Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/

			==References==
			<references/>

Rossdonaldson1: Rossdonaldson1 moved page Ostomy Complications to Ostomy complications

2021-02-18T16:57:31Z

Rossdonaldson1 moved page Ostomy Complications to Ostomy complications

← Older revision	Revision as of 16:57, 18 February 2021
(No difference)

Hoxbox: Created page with "==== Complications and ED management of colostomy, ileostomy, and urostomy.Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein htt..."

2021-02-02T15:43:40Z

Created page with "==== Complications and ED management of colostomy, ileostomy, and urostomy.<ref>Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein htt..."

New page

==== Complications and ED management of colostomy, ileostomy, and urostomy.<ref>Ostomy complications: ED presentations, complications, and management by Jonathan Bornstein http://www.emdocs.net/ostomy-complications-ed-presentations-complications-and-management/</ref> ====

← Older revision		Revision as of 16:59, 18 February 2021
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	==See Also==		==See Also==
			*[[Post-surgical complications]]

	==External Links==		==External Links==