Stoma Prolapse

  • Ursula M. Szmulowicz
  • Tracy A. Hull


Prolapse represents one of the most common late complications involving stomas. Stoma prolapse is categorized as either fixed or sliding. The presentation of stoma prolapse ranges from asymptomatic to incarcerated and strangulated. Primarily, stoma prolapse is a challenge for ostomy care. Numerous factors, both patient-related and technical, have been linked to the development of stoma prolapse. The risk of stoma prolapse is best addressed by a well-constructed stoma. Various modifications to the procedure have been proposed to reduce the incidence of stoma prolapse. For asymptomatic or minimally symptomatic patients, the prolapse can be initially treated by modifying or changing the stoma appliance. A more significant or symptomatic stoma prolapse mandates surgical intervention. A prolapsed stoma may be approached via a local parastomal revision or laparotomy. For a temporary stoma, prolapse is best treated by its reversal. Re-siting of the stoma may become necessary if local revision is unsuccessful. Incarceration and strangulation are uncommon sequelae of stoma prolapse. An incarcerated but viable prolapsed stoma may be initially managed conservatively by reducing the intestinal edema. The appearance of gangrene requires emergent surgical intervention.


Parastomal Hernia Distal Limb Loop Colostomy Transverse Colostomy Stoma Creation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Chandler JG, Evans BP. Colostomy prolapse. Surgery. 1978;84:577–82.PubMedGoogle Scholar
  2. 2.
    Gordon PH, Rolstad BS, Bubrick MP. Intestinal stomas. In: Nivatvongs S, Gordon PH, editors. Principles and practices of ­surgery for the colon, rectum, and anus. 2nd ed. St. Louis: Quality Medical Publishing; 1999. p. 1117–80.Google Scholar
  3. 3.
    Kim JT, Kumar RR. Reoperation for stoma-related complications. Clin Colon Rectal Surg. 2006;19:207–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Pearl RK. Complications of ileostomy. In: Nelson RL, Nyhus LM, editors. Surgery of the small intestine. Norwalk: Appleton & Lange; 1987. p. 499–509.Google Scholar
  5. 5.
    Pomeranz AA. An operation for prevention of ileostomy prolapse. Dis Colon Rectum. 1963;6:381–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Goldsmith HS, Tignor S, Byrne JJ. Terminal colostomy prolapse. Am J Surg. 1964;108:105–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Turnbull RB, Weakley FL. Atlas of intestinal stomas. St. Louis: C.V Mosby Company; 1967.Google Scholar
  8. 8.
    Stevenson JK, Volwiler W. Ileostomy stoma complications—­prevention and correction. In: Cooper P, Nyhus LM, editors. Surgery annual, vol. 3. New York: Meredith Corporation; 1971. p. 305–22.Google Scholar
  9. 9.
    Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR, et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum. 1999;42:1575–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Cheung MT. Complications of an abdominal stoma: an analysis of 322 stomas. Aust N Z J Surg. 1995;65:808–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Londono-Schimmer EE, Leong APK, Phillips RKS. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994;37:916–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg. 2001;88:360–3.PubMedCrossRefGoogle Scholar
  13. 13.
    García-Botello SA, García-Armengol J, García-Granero E, Espí A, Juan C, López-Mozos F, et al. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg. 2004;21:440–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs colostomy. Dis Colon Rectum. 2000;43:650–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Hoffman MS, Barton DPJ, Gates J, Roberts WS, Fiorica JV, Finan MA, et al. Complications of colostomy performed on gynecologic cancer patients. Gynecol Oncol. 1992;44:231–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl. 2005;87:427–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Law WL, Chu KW, Choi HK. Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg. 2002;89:704–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Leong APK, Londono-Schimmer EE, Phillips RKS. Life-table analysis of stomal complications following ileostomy. Br J Surg. 1994;81:727–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Porter JA, Salvati EP, Rubin RJ, Eisenstat TE. Complications of colostomies. Dis Colon Rectum. 1989;32:299–303.PubMedCrossRefGoogle Scholar
  20. 20.
    Wexner SD, Taranow DA, Johansen OB, Itzkowitz F, Daniel N, Nogueras JJ, et al. Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum. 1993;36:349–54.PubMedCrossRefGoogle Scholar
  21. 21.
    Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, et al. Prospective analysis of stoma-related complications. Colorectal Dis. 2005;7:279–85.PubMedCrossRefGoogle Scholar
  22. 22.
    Nogueras JJ, Wexner SD. Stoma prolapse. In: MacKeigan JM, Cataldo PA, editors. Intestinal stomas: principles, techniques, and management. St. Louis: Quality Medical Publishing, Inc.; 1993. p. 268–77.Google Scholar
  23. 23.
    Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998;41:1562–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Al-Salam AH, Grant C, Khawaja S. Colostomy complications in infants and children. Int Surg. 1983;77:164–6.Google Scholar
  25. 25.
    Çiğdem MK, Onen A, Duran H, Öztürk H, Otçu S. The mechanical complications of colostomy in infants and children: analysis of 473 cases of a single center. Pediatr Surg Int. 2006;22:671–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Lister J, Webster PJ, Mirza S. Colostomy complications in children. Practitioner. 1983;227:229–37.PubMedGoogle Scholar
  27. 27.
    Mollitt DL, Malangoni MA, Ballantine TV, Grosfeld JL. Colostomy complications in children. An analysis of 146 cases. Arch Surg. 1980;115:455–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Nour S, Beck J, Stringer MD. Colostomy complications in infants and children. Ann R Coll Surg Engl. 1996;78:526–30.PubMedGoogle Scholar
  29. 29.
    Pena A, Migotto-Krieger M, Levitt MA. Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg. 2006;41:748–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Allen-Mersh TG, Thomson JPS. Surgical treatment of colostomy complications. Br J Surg. 1988;75:416–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Duchesne JC, Wang Y-Z, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68:961–6.PubMedGoogle Scholar
  32. 32.
    McErlain D, Kane M, McGrogan M. Prolapsed stoma. Nurs Stand. 2004;18:41–2.PubMedGoogle Scholar
  33. 33.
    Weaver RM, Alexander-Williams J, Keighley MRB. Indications and outcome of reoperation for ileostomy complications in inflammatory bowel disease. Int J Colorectal Dis. 1988;3:38–42.PubMedCrossRefGoogle Scholar
  34. 34.
    Rosen S, Nogueras JJ. Stomal prolapse. In: Cataldo PA, MacKeigan JM, editors. Intestinal stomas: principles, techniques, and management. 2nd ed. New York: Marcel Dekker, Inc.; 2004. p. 307–22.CrossRefGoogle Scholar
  35. 35.
    Ng WT, Book KS, Wong MK, Cheng PW, Cheung CH. Prevention of colostomy prolapse by peritoneal tethering. J Am Coll Surg. 1997;184:313–5.PubMedGoogle Scholar
  36. 36.
    Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J, et al. A prospective audit of stomas—analysis of risk factors and complications and their management. Colorectal Dis. 2003;5:49–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Leenen LPH, Kuypers JHC. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum. 1989;32:500–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Steele MCA, Wu JS. Late stomal complications. Clin Colon Rectal Surg. 2002;15:199–207.CrossRefGoogle Scholar
  39. 39.
    Scudamore HH, Rogers AG, Bargen JA, Banner EA. Pregnancy after ileostomy for chronic ulcerative colitis. Gastroenterology. 1957;32:295–303.PubMedGoogle Scholar
  40. 40.
    Daly DW, Brooke BN. Ileostomy and excision of the large intestine for ulcerative colitis. Lancet. 1967;2:62–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Gopal KA, Amshel AL, Shonberg IL, Levinson BA, VanWert M, VanWert J. Ostomy and pregnancy. Dis Colon Rectum. 1985;28:912–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Nicholl MC, Thompson JM, Cocks PS. Stomas and pregnancy. Aust N Z J Obstet Gynaecol. 1993;33:322–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Wu JS, Fazio VW. Difficult stomas. In: Schrock TR, editor. Perspectives in colon and rectal surgery. St. Louis: Quality Medical Publishing, Inc.; 1998. p. 33–60.Google Scholar
  44. 44.
    Arun H, Ledgerwood A, Lucas CE. Ostomy prolapse in paraplegic patients: etiology, prevention, and treatment. J Am Paraplegia Soc. 1990;13:7–9.PubMedGoogle Scholar
  45. 45.
    Stothert JC, Brubacher L, Simonowitz DA. Complications of emergency stoma formation. Arch Surg. 1982;117:307–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Bass EM, Del Pino A, Tan A, Pearl RK, Orsay CP, Abcarian H. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum. 1997;40:440–2.PubMedCrossRefGoogle Scholar
  47. 47.
    Maeda K, Maruta M, Utsumi T, Sato H, Masumori K, Aoyama H. Pathophysiology and prevention of loop stomal prolapse in the transverse colon. Tech Coloproctol. 2003;7:108–11.PubMedCrossRefGoogle Scholar
  48. 48.
    Warren R, McKittrick LS. Ileostomy for ulcerative colitis: technique, complications and management. Surg Gynecol Obstet. 1951;93:555.PubMedGoogle Scholar
  49. 49.
    Kini SU, Perston Y, Radcliffe AG. Laparoscopically assisted trephine stoma formation. Surg Laparosc Endosc. 1996;6:371–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Mogilner JG, Rode H, Siplovich L, Cywes S. Bedside modified latex tube colopexy for the treatment of colostomy prolapse in children. Isr J Med Sci. 1990;26:410–1.PubMedGoogle Scholar
  51. 51.
    Abrams JS. Abdominal stomas: indications, operative techniques, and patient care. Boston: John Wright; 1984.Google Scholar
  52. 52.
    Gauderer MWL, Izant RJ. A technique for temporary control of colostomy prolapse in children. J Pediatr Surg. 1985;20:653–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Ein SH. Divided loop colostomy that does not prolapse. Am J Surg. 1984;147:250–2.PubMedCrossRefGoogle Scholar
  54. 54.
    Todd IP. Mechanical complications of ileostomy. Clin Gastroenterol. 1982;11:268–73.PubMedGoogle Scholar
  55. 55.
    Pearl RK, Prasad L, Orsay CP, Abcarian H, Tan AB. A survey of technical considerations in the construction of intestinal stomas. Am Surg. 1985;51:462–5.PubMedGoogle Scholar
  56. 56.
    Abcarian H, Pearl RK. Stomas. Surg Clin N Am. 1988;68:1295–305.PubMedGoogle Scholar
  57. 57.
    Whittaker M, Goligher JC. A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies. Dis Colon Rectum. 1976;19:342–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Jänes A, Cengiz Y, Israelsson A. Preventing parastomal hernia with a prosthetic mesh: a randomized study. Arch Surg. 2004;139:1356–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Israelsson LA. Preventing and treating parastomal hernia. World J Surg. 2005;29:1086–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Voitk A. Simple technique for laparoscopic paracolostomy hernia repair. Dis Colon Rectum. 2000;43:1451–3.PubMedCrossRefGoogle Scholar
  61. 61.
    Unti JA, Abcarian H, Pearl RK, Orsay CP, Nelson RL, Prasad L, et al. Rodless end-loop stomas: seven-year experience. Dis Colon Rectum. 1991;34:999–1004.PubMedCrossRefGoogle Scholar
  62. 62.
    Ecker KW, Schmid T, Xu HS, Feifel G. Improved stabilization of conventional (Brooke) ileostomies with the stapler technique. World J Surg. 1992;16:525–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Riaz AA, Thompson HH. Split transverse colostomy: an alternative method of defunctioning the distal colon. Tech Coloproctol. 2006;10:57–60.PubMedCrossRefGoogle Scholar
  64. 64.
    Golladay ES, Bernay F, Wagner CW. Prevention of prolapse in pediatric enterostomas with purse string technique. J Pediatr Surg. 1990;25:990–1.PubMedCrossRefGoogle Scholar
  65. 65.
    Fuhrman GM, Ota DM. Laparoscopic intestinal stomas. Dis Colon Rectum. 1994;37:444–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Fucini C. A simple device for prolapsing loop colostomies. Dis Colon Rectum. 1989;32:534–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Hsieh M-Y, Liu C, Ho S-H, Wung S-H, Chin T, Wei C. Simple device for treating prolapsing loop colostomy. J Chin Med Assoc. 2006;69:138–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Sohn N, Schulman N, Weinstein MA, Robbins RD. Ileostomy prolapse repair utilizing bidirectional myotomy and a meshed split-thickness skin graft. Am J Surg. 1983;145:807–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Agrez MV. Revision of transverse colostomy prolapse without stoma resiting. Ann R Coll Surg Engl. 1997;79:383–4.PubMedGoogle Scholar
  70. 70.
    Abulafi AM, Sherman IW, Fiddian RV. Délorme operation for prolapsed colostomy. Br J Surg. 1989;76:1321–2.PubMedCrossRefGoogle Scholar
  71. 71.
    Canil K, Fitzgerald P, Lau G, Cameron G, Walton M. Button-pexy fixation for repair of ileostomy and colostomy prolapse. J Pediatr Surg. 1995;30:1148–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Corry M. Colostomy prolapse [letter]. Br J Surg. 1984;71:81.PubMedCrossRefGoogle Scholar
  73. 73.
    Krasna IH. A simple purse string suture technique for treatment of colostomy prolapse and intussusception. J Pediatr Surg. 1979;14:801–2.PubMedCrossRefGoogle Scholar
  74. 74.
    Hata F, Kitagawa S, Nishimori H, Furuhata T, Tsuruma T, Ezoe E, et al. A novel, easy, and safe technique to repair a stoma prolapse using a surgical stapling device. Dig Surg. 2005;22:306–10.PubMedCrossRefGoogle Scholar
  75. 75.
    Tepetes K, Spyridakis M, Hatzitheofilou C. Local treatment of a loop colostomy prolapse with a linear stapler. Tech Coloproctol. 2005;9:156–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Maeda K, Maruta M, Utsumi T, Sato H, Aoyama H, Katsuno H, et al. Local correction of a transverse loop colostomy prolapse by means of a stapler device. Tech Coloproctol. 2004;8:45–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Fligelstone LJ, Wanendeya N, Palmer BV. Surgical workshop: osmotic therapy for acute irreducible stoma prolapse. Br J Surg. 1997;84:390.PubMedCrossRefGoogle Scholar
  78. 78.
    Myers JO, Rothenberger DA. Sugar in the reduction of incarcerated prolapsed bowel: report of two cases. Dis Colon Rectum. 1991;34:416–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Chaudhuri A, Prasai A. Hyaluronidase in the reduction of prolapsed colostomy. Ann R Coll Surg Engl. 2003;85:209.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryCleveland Clinic FoundationClevelandUSA
  2. 2.Department of Colon and Rectal Surgery, Digestive Disease InstituteCleveland Clinic FoundationClevelandUSA

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