Differential Diagnosis for a Non-Functioning Colostomy
- Single most likely diagnosis:
- B. Tension on blood supply: This is a common issue that can lead to ischemia of the bowel segment used for the colostomy, resulting in its dysfunction. Tension on the blood supply can compromise the viability of the stoma, leading to poor function or necrosis.
- Other Likely diagnoses:
- C. Early ileus, later hard feces or bowel obstruction: These conditions can directly affect the functioning of the colostomy. An ileus can prevent the normal movement of bowel contents through the stoma, while hard feces or a bowel obstruction can physically block the stoma, preventing it from functioning properly.
- A. Skeletonization off the epiploic fat and mesentry: Although less directly related to the immediate function of the colostomy, damage to the mesenteric blood supply during surgery (which could be implied by the term "skeletonization") can lead to ischemia and dysfunction of the stoma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Necrotizing fasciitis or perforation: Although rare, these complications can arise from ischemia or obstruction and can be life-threatening if not promptly diagnosed and treated.
- Herniation through the stoma site: This can lead to bowel obstruction or strangulation, which are medical emergencies.
- Rare diagnoses:
- Chronic conditions affecting bowel motility: Conditions like chronic intestinal pseudo-obstruction can affect the function of the colostomy, although they would be less common causes of immediate post-surgical dysfunction.
- Adhesions: While not immediately life-threatening, adhesions can form over time and cause bowel obstruction, affecting the colostomy's function. However, this would typically be a later complication rather than an immediate cause of dysfunction.