Ostomy edema case sharing

Share a case of stoma edema seen in the customer group. On Wednesday morning, Mr. Zhao found stoma edema accompanied by constipation in the morning, so he came to consult our stoma nurse. The following is the shape of Mr. Zhao's stoma, as shown in the figure below:

Assess Mr. Zhao's stoma shape:

The appearance of the colostomy was larger and more prominent than expected, with a reddish appearance, the stoma was swollen and shiny, and the folds on the mucous membrane of the colostomy disappeared completely.

Ostomy edema manifestations:

Stoma edema refers to the swelling of the stoma mucosa, which manifests as varying degrees of swelling of the colostomy mucosa, and is the most common complication after a colostomy. The initial postoperative edema is reddish, translucent, firm in texture, and varies in color from pink to dark red. Mostly due to blood reflux disorder, no symptoms, mild edema can recover naturally after 6-8 weeks. If the edema of the stoma tissue is not relieved for a long time, it is related to the tight wrapping of the tissue around the wound edge, infection, removal of stoma stenosis, and obstruction of venous return. If the stoma mucosa is edematous and is grayish-white at home, you should check whether the blood supply to the stoma is normal.

What causes ostomy edema?

1. Surgical trauma

sharp dissection, and foreign body touch during the process of enterostomy edema . The main manifestations are congestion and edema.

2. Stress in the gut

Under normal physiological conditions, the intestinal tube has always existed in the human abdominal cavity with a constant temperature. When the intestinal tube is pulled out of the body and directly exposed to the air, changes in the external environment such as temperature changes and air changes directly affect the intestinal stoma. , Enterostomy edema is one of the stress responses of intestinal intolerance to the new environment.

3. Obstructed blood and lymphatic flow

It may be because the opening of the chassis is too small when the ostomy bag is cut or the opening of the enterostomy in the abdominal wall is too small so that the mucosa of the enterostomy is compressed by the chassis or surrounding tissues. When scarring occurs due to poor wound healing, it may also compress the enterostomy, restricting the blood circulation of the enterostomy mucosa to a certain extent, and resulting in mucosal tissue edema.

4. Hypoproteinemia

When the protein content in the blood is too low, the water in the blood will penetrate into the interstitial space, which will lead to enterostomy edema.

Although there are many causes of colostomy edema, the stoma edema seen in the initial stage of colostomy opening will naturally subside 6 to 8 weeks after surgery, but severe stoma edema requires medical intervention to correct. Therefore, in the nursing process, it is necessary to observe and evaluate the cause of the occurrence before corresponding treatment can be carried out.

What is the cause of ostomy edema?

1. Wearing the abdominal girdle too tight leads to stoma edema

2. Improper cutting of the stoma chassis after surgery, the center hole of the chassis is too small, compressing the surrounding of the stoma canal, affecting blood flow and causing stoma edema

3. Hypoproteinemia. When the protein content in the blood is too low, the water in the blood will penetrate into the interstitial space, which will lead to enterostomy edema.

4. The local recurrence of local tumor stoma forms compression, which leads to obstruction of blood flow back into the stoma, resulting in intestinal stomal edema

5. The length of the bowel and the double-loop stoma of the support rod. During the operation, the bowel is not free enough or the patient is too obese, the tension of the bowel is too large, and the pressure of the support rod is too large, which will lead to stomal edema.

What are the treatment measures?

1. Mild edema does not need to be treated temporarily. Because most colostomy patients will have mild swelling in the early postoperative period, this edema will gradually relieve itself within 6-8 weeks after surgery, and usually does not cause damage to the patient.

2. For Severe edema (usually occurs about a week after surgery), then use gauze dipped in 50% magnesium sulfate solution or hypertonic saline (3% sodium chloride solution) to cover the enterostomy mucosa, 2-3 times/ day, 20-30 minutes/time. It is advisable to stick the ostomy bag before wet compress to avoid discomfort caused by wet clothes.

3. Choice of ostomy bag. Switch to a two-piece ostomy bag and wet compress 3 times a day. In the early stage of edema, when the volume of the enterostomy is large, it is advisable to use a pouch with a larger diameter in the center hole of the chassis to avoid mucosal erosion caused by friction between the pouch and the intestinal mucosa. A small amount of gas can also be placed in the pouch to prevent friction.

4. In the early postoperative period, except that the inner ring of the ostomy bag chassis should be slightly larger, the abdominal girdle should not be too tight, and the stoma should not be completely tied in the abdominal girdle.

5. For patients with enterostomy edema caused by hypoproteinemia, they should actively follow the doctor's advice to correct the patient's protein level, treat the primary disease, and pay attention to the treatment effect in the later stage.

6. The color of the stoma with edema should be closely observed to avoid ischemic necrosis. Avoid colostomy mucosal injury and ischemia.

For more information on longterm medical ostomy pouch, refer to the previous articles. If you have customized needs, you are welcome to contact us; we will serve you wholeheartedly.

At Longterm Medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia

Date: October28, 2022