What is the rate of stoma prolapse amongst individuals with tetraplegia (spinal cord injury resulting in partial or complete paralysis of all four limbs)?

Stoma Prolapse Rates in Individuals with Tetraplegia

The rate of stomal prolapse in individuals with tetraplegia is approximately 5-10%, which is similar to the general population rate. 1

Understanding Stoma Prolapse

Stoma prolapse refers to the elongation of the intestinal portion of the stoma, as opposed to a parastomal hernia which is a bulge in the skin and soft tissue surrounding the ostomy. 1

Key characteristics:

• Occurs in 5-10% of all stoma patients, including those with tetraplegia 1
• More common in loop colostomies than other stoma types 2
• Typically occurs in the distal limb of loop stomas 2
• Usually associated with redundant colon invading the stoma with increased abdominal pressure 2

Complications of Stoma Prolapse in Tetraplegic Patients

Stoma prolapse can lead to several complications that may be particularly problematic for individuals with tetraplegia:

• Acute prolapse complications: Can lead to incarceration and ischemia, presenting as pain, obstipation, and purple/black discoloration of the stoma 1
• Emergency situations: Ischemic prolapse requires emergency surgery 1
• Stoma care difficulties: Causes leakage, obstruction, and sometimes incarceration 3
• Skin complications: May lead to peristomal skin issues, which are already common in patients with ostomies 1

Management Considerations for Tetraplegic Patients

Management of stoma prolapse in tetraplegic patients may require special consideration due to their physical limitations:

• Conservative management: In the absence of ischemia, prolapse may be reduced by laying the patient in a relaxed position and gently squeezing the ostomy back into the abdomen 1
• Sugar application: If the stoma cannot be reduced with pressure alone, applying a cup of sugar directly to the stoma and leaving it in place for 20 minutes may help with reduction 1
• Surgical options: Several techniques exist for managing prolapse that cannot be reduced:
  • Local correction using linear stapler devices under minor sedation 4, 5
  • Laparoscopic enteropexy for prolapsing stoma (LEPS) 6
  • The "Phillips" ileostomy correction technique 3
  • Fixation of the colon to the fascia during initial stoma creation to prevent prolapse 2

Prevention Strategies

Prevention of stoma prolapse in tetraplegic patients should focus on:

• Proper stoma site selection: Marking allows for assessment of the abdomen in multiple positions for a site within the rectus muscle, away from scars, skin folds, bony prominences, and the umbilicus 1
• Preoperative education: Wound ostomy and continence (WOC) consultation is essential 1
• Proper fixation: Fixation of the colon to the fascia during stoma creation may help prevent prolapse 2
• Regular monitoring: Early identification of prolapse can prevent complications 1

Special Considerations for Tetraplegic Patients

Individuals with tetraplegia face unique challenges with stomas:

• Higher risk of thrombo-embolism: May be seen in 7-100% of patients with tetraparesis and inadequate prophylaxis 1
• Pressure sores: Common with prolonged immobilization, particularly after 48-72 hours 1
• Respiratory complications: A significant concern in immobilized patients 1
• Self-care challenges: Difficulty with stoma management due to upper limb paralysis 1

While specific data on stoma prolapse rates exclusively in the tetraplegic population is limited, the available evidence suggests that the rate is similar to the general population at 5-10%, with management requiring special consideration of the physical limitations and complications associated with tetraplegia.