Case sharing of edema after enterostomy

Postoperative stoma edema is also a common problem for some stoma friends. How to care for stoma edema after stoma surgery? Please follow me to take a look.

What is stoma edema?

Enterostomy edema refers to swelling of the stoma mucosa and is the most common complication after enterostomy surgery. Any type of enterostomy, including ileostomy, colostomy, and urostomy, may have varying degrees of edema in the early or late postoperative period. The normal appearance of the enterostomy mucosa is bright red or pink, with a smooth and moist surface. The height is 1.5cm slightly higher than the skin or at the same level as the skin surface, which is convenient for protecting the skin around the enterostomy when pasting the stoma bag.

Clinical manifestations of enterostomy edema:

The appearance of stoma edema is larger and more prominent than the expected diameter, red or pink, the stoma is swollen and shiny, and the folds on the enterostomy mucosa partially or completely disappear.

What is the cause of stoma edema?

1. Surgical trauma :

Some edema is a short-term inflammatory reaction caused by intestinal trauma caused by traction, sharp dissection, and foreign body contact during the operation. The main symptoms are hyperemia and edema.

2. Intestinal stress :

Stress response of enterostomy intolerance to a new environment. Postoperatively, since the intestinal tube is pulled out of the body and directly exposed to the air, changes in the external environment, such as changes in temperature and air, all directly affect the enterostomy water.

3. Blockage of blood and lymphatic return :

In daily stoma care, because the cutting opening of the stoma chassis is too small, the enterostomy mucosa is compressed by the chassis or surrounding tissues. When the wound at the stoma is poorly healed and scarring occurs, it will also press the enterostomy, restricting the blood circulation of the enterostomy mucosa, and resulting in edema of the mucosal tissue.

4. Hypoproteinemia :

When the protein content in the blood is too low, the water in the blood will penetrate the interstitial space, which will cause edema during the enterostomy. Although there are many reasons for the edema of the enterostomy, the stoma edema seen at the initial stage of the opening of the enterostomy can naturally subside after 6 to 8 weeks, but severe stoma edema requires medical intervention to correct it. Therefore, in the nursing process, it is necessary to observe and evaluate the cause of the occurrence before performing the corresponding treatment.

How to treat stoma edema?

1. Mild stoma edema:

 Early postoperative edema will gradually relieve within 6-8 weeks after the operation, and no special treatment is required.

Nursing measures:

Before changing the stoma bag, measure the size of the stoma first. The center hole of the chassis should be 1~2mm larger than the stoma root.

2. Severe stoma edema:

The volume of the enterostomy increases significantly, and the tissue fluid in the enterostomy mucosa, submucosal microvessels or interstitial spaces concentrates, resulting in an obvious pink color of the enterostomy mucosa, and folds on the enterostomy mucosa Completely disappear.

Nursing measures:

1. Pay attention to the cutting of the chassis to avoid damage to the intestinal stoma mucosa and ischemia.

2. Choose an ostomy bag with a larger chassis diameter. When cutting the chassis, it should be slightly larger than the stoma mucosa by about 2mm, so as to avoid the stoma with a swollen stoma that affects blood circulation and leads to ischemic necrosis.

If the stoma edema is serious and you cannot evaluate it by yourself, it is recommended to seek medical treatment in time and seek medical help.

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Editor: kiki Jia

Date: March 3, 2023