Colostomy Obstruction _best_
Write-Up: Colostomy Obstruction 1. Definition A partial or complete blockage of the bowel lumen at or near the stoma site, preventing the passage of stool and flatus through the colostomy. 2. Pathophysiology
Mechanical blockage within the stoma or proximal colon. Results in accumulation of fecal matter and gas proximal to the obstruction. Leads to abdominal distension, pain, nausea, and potential perforation or stoma necrosis if untreated.
3. Common Causes
Dietary: High-fiber foods (corn, nuts, seeds, raw vegetables, fruit skins). Adhesive/Stenosis: Scarring or narrowing at the skin or fascial level (late complication). Herniation: Parastomal hernia causing bowel kinking. Fecal Impaction: Hard, dry stool within the stoma or proximal limb. Volvulus: Twisting of the bowel around the stoma (rare). Adhesions: Internal bands proximal to the stoma. colostomy obstruction
4. Risk Factors
Poor chewing of food. Inadequate fluid intake. Parastomal hernia. Previous stomal stricture or surgery. Non-softening diet post-colostomy.
5. Clinical Presentation History
No output from colostomy for >8–12 hours (if normally active). Absent flatus (gas). Cramping abdominal pain, nausea, vomiting. Possible watery discharge (overflow diarrhea around the blockage).
Physical Exam
Stoma: Pale, dry, swollen, or dusky appearance. No stool/gas with gentle irrigation attempt. Abdomen: Distended, tympanic to percussion, tender (may be localized or diffuse). Peristalsis: High-pitched or absent bowel sounds (early: increased, late: absent). Write-Up: Colostomy Obstruction 1
6. Differential Diagnosis | Condition | Distinguishing Feature | |-----------|------------------------| | Parastomal hernia | Reducible bulge, often still passes stool | | Stoma stenosis | Gradual narrowing over weeks/months | | Post-op ileus | Occurs days after surgery, no mechanical cause | | Small bowel obstruction | More proximal, bilious vomiting, distal stoma silent | | Constipation | Hard stool in remaining colon, but stoma may still pass small amounts | 7. Investigations
Abdominal X-ray (KUB): Dilated colon proximal to stoma, possible air-fluid levels, absence of gas in stoma bag. Contrast enema (through stoma): To confirm level and cause of obstruction (avoid if peritonitis suspected). CT scan: If suspect hernia, volvulus, or intra-abdominal pathology. Blood tests: Electrolytes, renal function, lactate (if ischemia suspected).
