EP601 - Avoiding The Hostile Abdomen: Local Repair Of Ostomy Prolapse, A Case Series

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Purpose/Background: Ostomy prolapse leads to multiple trips to the emergency department for significant discomfort, obstruction, and vascular compromise. The most definitive surgical repair is reversal of the ostomy itself, but an intra-abdominal reduction and pexy is a well described method. However, an ostomy is often created in the setting of a hostile abdomens. Attempts to avoid an intraabdominal approach may be advisable. Local resection of prolapsed tissue can be a great alternative.

Methods/Interventions: Here we discuss a case series of successful local repair of loop ileostomy and end colostomy prolapse and provide step-by-step guidance to our surgical colleagues who want to avoid an intrabdominal approach.

Results/Outcomes: Case Description – Loop Ileostomy
A 23-year-old female patient presented to the emergency department with incarcerated 15cm of prolapsed loop ileostomy. She had a history of Crohn’s disease on methotrexate and adalimumab, and severe anorectal disease with fistulae and stenosis. Given her history of inflammatory bowel disease and patient preference, we decided to proceed with local repair of ostomy prolapse (Figure 1). The next day, this patient had adequate ostomy output, and she was discharged home with satisfactory appearance and function of ostomy upon follow up visits in the office.

Case Description – End Colostomy
85-year-old male patient presented for outpatient evaluation of prolapsing colostomy with issues of pouching and significant impact on quality of life. He has a past medical history of prostate cancer metastatic to the rectum with surgical history of diverting colostomy followed by revision with end colostomy creation due to prolapse with incarceration. Discussed option for abdominal approach with take down, resection, revision, and hernia repair vs local revision. Decision made to proceed with local revision to avoid entering the abdomen. Steps of the local staple repair are as followed. He tolerated the procedure well and the colostomy was function prior to discharge. Upon 3 weeks follow up, no further prolapse and patient was satisfied with improved pouching of ostomy.

Conclusion/Discussion: This case series provides step by step guidance for a local repair of loop ileostomy and end colostomy prolapse. This technique would be especially appropriate for patients with hostile abdomens, or who otherwise are not optimal surgical candidates for an intra-abdominal approach.