Editing Stomal complications (section)

=== Stomal stenosis ===

** Narrowing sufficient to      interfere with normal function
** Most common with end      ileostomy
** Pathophysiology:
*** Secondary to scarring or       tightness of the mucocutaneous junction
*** Peristomal sepsis
*** Retraction
*** Ill-fitting pouch
*** Suboptimal surgical       technique
*** Crohns
*** Malignancy
** Most likely to develop      months later
** Early stenosis - manage      conservatively, should improve as the oedema settles - insert a large      36Fr soft-tipped Foley catheter just beyond the fascia, without inflating      the balloon
** Later stenosis
*** Mild - dietary       modifications - avoid insoluble fibre. Gentle routine dilatation of       stoma may help but not evidence-based.
*** Significant - cramping pain       followed by explosive output. Usually requires surgical correction.       Local revision may be preferred to dilatation. Enlargement of the skin       opening may be useful in some situations.