Stomal necrosis

Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg. 2019 May;32(3):176-182.

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“Stomal necrosis has been reported to occur in up to 20% of ostomates in the immediate postoperative period ([Fig. 1]).[3] Specific risk factors for stoma necrosis include emergent operation, inadequate mobilization of the bowel, excessive mesenteric resection resulting in inadequate arterial blood supply to or venous drainage from the bowel, and constriction in the abdominal wall due to excessively small openings in the fascia, abdominal wall mesh, or skin.[10] [20] Importantly, the obese patient is seven times more likely to experience stoma necrosis than the nonobese patient.[21] Stoma necrosis is much less common for loop stomas given the dual blood supply to both the afferent and efferent limbs.”

Kwiatt M, Kawata M. Avoidance and management of stomal complications. Clin Colon Rectal Surg. 2013 Jun;26(2):112-21.

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“Excessive trimming of the epiploic fat and the mesentery should be avoided. In general, an end ileostomy will maintain adequate blood supply with dissection of the mesentery for up to 5 cm from the distal end. [53] Collateral flow is maintained through the submucosa of the terminal ileum. Colonic arterial flow is maintained through the marginal artery; at least a 1 cm portion of the colonic mesentery adjacent to the bowel wall should be preserved to maintain patency of the marginal artery. Confirmation of pulsatile flow by digital palpation of the preserved colonic mesentery is recommended and generally ensures viability of the colostomy.”

See also: Krishnamurty DM, et al. Stoma Complications. Clin Colon Rectal Surg. 2017 Jul;30(3):193-200.

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