Clever use of pacifiers to treat stoma prolapse

Stoma prolapse is a common complication after stoma surgery, and it's an undeniable reality that any type of stoma carries the risk of prolapse. However, not all prolapses require immediate surgical intervention. For certain emergency situations that are suitable for non-surgical treatment, mastering the correct home emergency management methods is crucial.

Why does stoma prolapse occur ?

1. Surgical-related factors : These form the anatomical basis for prolapse. The most common cause is problems with the establishment of the stoma during surgery, such as an excessively large abdominal opening that provides space for the intestines to protrude outwards. Secondly, insufficient mesenteric fixation or inadequate postoperative adhesion between the intestines and the abdominal wall allows for excessive intra-abdominal mobility, making the intestines prone to movement with pressure changes. Improper stoma placement, such as lateral to the rectus abdominis muscle where there is a lack of muscle restraint, also increases the risk of prolapse.
2. Postoperative care and individual physical factors : Any factor that causes a sudden or sustained increase in intra-abdominal pressure can induce prolapse. Common causes include: behaviors that suddenly increase abdominal pressure, such as chronic coughing, sneezing, or straining during bowel movements; engaging in heavy physical labor or strenuous exercise; abdominal fat accumulation due to weight gain; and increased intestinal pressure caused by chronic constipation or intestinal obstruction. These factors, alone or in combination, force the intestines to protrude outward through the relatively weak stoma.

What are the clinical manifestations of stoma prolapse ?

Normally, a colostomy protrudes about 1-2 cm from the abdominal wall, and an ileostomy about 2-3 cm. When prolapse occurs, the intestinal segment extends outward from the stoma, reaching several centimeters or even more than ten centimeters in length. This prolapsed segment of intestine appears pink or dark red, and is tubular or rod-shaped, with mucosal edema on its surface.

Mid-stage symptoms include local discomfort and functional impairment . Patients may experience swelling or pain in the stoma area, especially when standing, coughing, or straining. Prolapsed bowel segments may impair excretion, leading to poor drainage or difficulty in attaching the ostomy bag, increasing the risk of leakage. Furthermore, exposed bowel segments can cause mucosal dryness and friction damage.

If the prolapsed intestine turns dark purple or black, accompanied by severe pain and cessation of gas and stool passage through the stoma, this indicates possible incarceration or strangulation, meaning the intestine is stuck at the stoma, obstructing blood supply. This is a surgical emergency and requires immediate medical attention.

Procedure for treating stoma prolapse using a nipple :

Step 1:

Instruct the patient to immediately lie flat with legs bent to relax abdominal muscles. The operator should thoroughly wash hands with soap and running water. Prepare the following items: a brand new silicone baby pacifier, sterile gauze, saline or cooled boiled water, and silicone gel tape.

Step 2:

Gently wrap the prolapsed intestinal segment with sterile gauze soaked in saline solution, keeping it moist while observing its color and texture. Only attempt to reduce it if the intestinal segment remains normal in color (pink or red), shows no signs of ulceration, and there is no severe pain. If the intestinal segment darkens, turns purple, or blackens, do not attempt to reduce it; seek immediate medical attention.

Step 3:

Moisten the nipple with saline solution to increase lubrication. Gently support the base of the prolapsed intestine with a damp gauze in one hand, and hold the nipple in the other hand, gently pressing the bulbous tip of the nipple against the center of the end of the intestine. Apply continuous, gentle pressure along the long axis of the intestine to guide it to slowly retract. The pressure must be even and gentle, avoiding sudden force or rapid advancement .

Step 4:

Once the intestines have fully retracted, do not remove the nipple immediately. Gently place the disc portion of the nipple over the stoma, providing continuous, gentle pressure. Secure the nipple to the abdominal skin with medical tape in a crisscross pattern, ensuring a firm but not excessive hold.

Do not attempt this if the following occurs:

1. Abnormal color of the intestinal tract (darkened, purple, or black)
2. Ulceration and bleeding appear on the surface of the intestine.
3. The patient experiences severe pain, nausea, and vomiting.
4. Accompanied by cessation of gas and bowel movements at the stoma.

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Editor: kiki Jia