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Monday, February 1, 2021

Ostomy complications

EmDOCs  - February 01, 2021 - By Jonathan Bornstein; Jennifer Liao; Marzena Sroczynski; Carlos Rodriguez. Reviewed by: Alex Koyfman; Brit Longnand Caitlyn Costanzo
“Pearls:
  • Ileostomies tend to be on the right side of the abdomen and have loose liquid stool; colostomies tend to be on the left side of the abdomen and have more formed stool; urostomies tend to be on the right side of the abdomen and produce urine.
  • High output failure
    • Be aware of this in the dehydrated patient with a new gastrointestinal ostomy who is putting out 1.5-2 L fluid/day.
    • IV fluid resuscitation and electrolyte replacement are essential. Pay particular attention to signs of severe hyponatremia, hypokalemia, and hypomagnesemia.
    • Consider adv anced imaging to assess for complications such as anastomotic leak, obstruction, or paralytic ileus.
  • Stomal necrosis, incarcerated parastomal hernias, and internal reservoir ruptures are surgical emergencies – do not delay in resuscitating your patient and calling your surgical consultants early.
  • Not all patients with urostomies and evidence of bacteriuria require antibiotics – it is common for their urine to be colonized with bacteria from the ileal conduit. Reserve antibiotics for patients with systemic signs of infection”