Treatment of Stomal Prolapse Causing Septic Shock

Immediate surgical intervention is required for patients with stomal prolapse causing septic shock due to the high risk of mortality. 1

Initial Assessment and Stabilization

Patients with stomal prolapse causing septic shock require prompt resuscitation with IV fluids, vasopressors if needed, and empiric broad-spectrum antibiotics before definitive surgical management 1, 2
Laboratory tests should include complete blood count, serum creatinine, and inflammatory markers (e.g., C-reactive protein, procalcitonin, and lactates) to assess severity of sepsis 1, 2
Imaging should not delay management in hemodynamically unstable patients, but when feasible, CT scan can help identify complications such as perforation or obstruction 2

For hemodynamically unstable patients with stomal prolapse causing septic shock, an abdominal open approach is strongly recommended 1
The presence of peritonitis or septic shock from stomal prolapse necessitates an abdominal approach rather than local repair 1
In patients requiring resectional surgery, the decision between primary anastomosis and terminal colostomy should be based on the patient's clinical condition and risk of anastomotic leakage 1

For strangulated stomal prolapse with gangrene/perforation, formal resection with creation of a new stoma is indicated 1
In septic shock, priority must be given to controlling the source of sepsis with minimal operative time 1
Terminal colostomy is often preferred over primary anastomosis in the setting of septic shock to minimize risk of anastomotic leak 1

Empiric broad-spectrum antimicrobial therapy should be administered immediately in patients with stomal prolapse causing septic shock 1
The antibiotic regimen should be based on the patient's clinical condition, individual risk for multi-drug resistant organisms, and local resistance epidemiology 1, 2
After source control is achieved, antibiotics should be continued and adjusted based on culture results and clinical response 1

Once the patient has recovered from septic shock, consideration should be given to definitive management to prevent recurrence 1, 3
If the stoma is temporary, reversal should be considered once the patient has fully recovered 1, 3
For permanent stomas, techniques to prevent recurrence include proper fixation of the intestine to the abdominal wall and elimination of space between the stoma and abdominal wall 3

Delayed recognition of stomal ischemia can lead to progression to septic shock; any discoloration of stoma (purple/black) requires immediate surgical evaluation 1
Conservative measures like sugar application or manual reduction are contraindicated in the setting of ischemia, perforation, or septic shock 1, 4
Attempting local repair techniques in the setting of septic shock can delay definitive treatment and worsen outcomes 5, 6, 7
The mortality rate for perforated bowel with diffuse peritonitis can reach 19-65%, emphasizing the need for prompt surgical intervention 1