What is stoma necrosis
In simple terms, stoma necrosis happens when the blood supply to the stoma is reduced or cut off, causing part or all of the stoma tissue to die. Healthy stoma tissue depends on a steady flow of blood, so when that flow is disrupted, the tissue can't survive.
When does stoma necrosis happen?
It's considered an early complication as it usually shows up within the first 24 hours after surgery, though it can develop any time in the first five days. It can also arise later as a result of a hernia, prolapse, or injury to the stoma.
Necrosis is more often linked to emergency surgery and tends to affect colostomies more than ileostomies or urostomies. Several surgical factors can play a role, such as the stoma being brought up under tension, which can happen with abdominal swelling, obesity, or stitches placed too tightly or too close together around the stoma. It can also result from a blood clot interrupting circulation, or from abdominal factors like a thick abdominal wall, swelling, distension, or obesity. Post-operative issues such as significant blood loss or low blood pressure can contribute too.
Types of stoma necrosis
Necrosis is generally classed as either partial (superficial) or complete (deep), with partial necrosis being the more common of the two. How severe it is comes down to how much blood the stoma was getting during and after surgery.
Your colorectal surgeon may spot signs of partial necrosis during or shortly after the operation and will check how much tissue has been affected. This usually involves examining the colour of the stoma's inner lining using a light source, sometimes with a proctoscope or a thin lubricated scope (a bit like a mini internal examination) often while you're still under anaesthetic. If necrosis looks serious enough, it may be corrected during the same surgery.
Where necrosis is only partial or superficial, your surgeon may choose to leave it rather than operate again, since it often improves on its own. Even so, both your surgeon and your stoma care nurse will keep a close eye on it to make sure it's healing and not getting worse.
Complete or deep necrosis, on the other hand, doesn't always show up straight away; it can take several days to become obvious. If you've already been discharged by the time this happens, get in touch with your community stoma care nurse straight away.
What does a stoma necrosis look like?
A necrotic stoma typically changes colour and ranges from a dark maroon to black and can turn grey as the tissue deteriorates further. It often feels soft, floppy, and cool or cold to the touch, rather than the firm, warm, pink tissue you'd expect from a healthy stoma.
How is a stoma necrosis treated?
Partial stoma necrosis often resolves on its own. The affected surface tissue can gradually slough away during cleaning, uncovering healthy pink tissue underneath. Wearing a clear pouch during this stage makes it easier for you and your care team to keep watch on the stoma without needing to disturb it. Your stoma nurse may also give you a powder to apply regularly, which helps the dead tissue shed and encourages healing, and if you're using a two-piece appliance, it's easier to reapply the powder as often as needed. Staying active and keeping the stoma warm can also support blood flow and recovery.
For more extensive necrosis; for instance, where the damage goes deeper than about 2cm, surgery to remove the affected tissue may be needed. In this case too, a clear pouch is usually recommended, and the nursing team will make sure your appliance fits well without putting extra pressure on the stoma.
Why early recognition is so important with a stoma necrosis
Stoma necrosis can sound frightening, but catching it early makes a lot of difference to how easily it's resolved. Left unmanaged, it can lead to further complications such as a short-spouted stoma, a retracted stoma (sitting flush with or below skin level), dehiscence (breakdown of the skin around the stoma's edge), or stenosis (narrowing of the stoma), all of which can then bring on their own issues like stoma leakage and peristomal skin irritation.
The good news is that all of these related complications can be managed with the right appliance and close monitoring. If you notice any changes to your stoma's colour, texture, or temperature, don't wait; speak to your stoma care nurse for advice.
FAQ: Stoma necrosis
What is a stoma necrosis?
Stoma necrosis is when the blood supply to the stoma is reduced or cut off, causing the tissue to die. It's an early complication that most often appears within the first 24 hours after surgery, though it can occur up to five days afterwards. Signs include the stoma turning dark maroon, black, or grey, and feeling cool, soft, or floppy rather than warm and firm. It's uncommon but needs prompt attention from your stoma care team.
What late complications can occur with a stoma?
Complications that show up later on can include a retracted stoma, stenosis (narrowing of the stoma), dehiscence (skin breakdown around the stoma's border), and a short-spouted stoma — all of which can sometimes follow on from earlier issues like necrosis if it isn't properly monitored. These can affect how well your appliance fits and may lead to stoma leakage or skin irritation, so it's worth having any changes reviewed by your stoma care nurse.