Most Likely Cause of Poorly Functioning Colostomy
The most likely cause of a poorly functioning colostomy is option C: early ileus, later hard faeces, or bowel obstruction, as these represent the most common structural and functional problems affecting stoma output and function. 1
Clinical Reasoning
The 2023 AGA guidelines on ostomy management clearly identify that structural problems including stomal stricture or dysfunction, intestinal obstruction, and ileus are primary etiologies of ostomy malfunction 1. These complications directly impair the ability of the stoma to function properly by preventing normal passage of stool.
Early Postoperative Period
- Ileus is a common early complication that prevents normal stoma output in the immediate postoperative period 1
- Early dysfunction often relates to the stoma not yet establishing normal function as bowel motility returns 1
Late/Chronic Dysfunction
- Hard feces and bowel obstruction become more prominent causes of malfunction beyond 3 weeks post-surgery 1
- The etiology of late dysfunction specifically includes stomal stricture, intestinal obstruction, and ileus as structural problems 1
- Stomal stenosis (stricture) occurs in a significant number of patients and directly impairs stool passage 2
Why Other Options Are Less Likely
Option A: Skeletonization of Epiploic Fat and Mesentery
- While excessive skeletonization can theoretically compromise blood supply, this is more of a technical surgical consideration during stoma creation rather than a cause of malfunction once the stoma is established 3
- This would more likely lead to ischemia/necrosis rather than simple "not functioning well" 2
Option B: Tension on Blood Supply
- Tension on blood supply typically manifests as stomal ischemia or necrosis, which is a distinct complication rather than general malfunction 2
- Vascular compromise presents acutely with visible changes to the stoma (dusky appearance, necrosis) rather than as functional obstruction 2
- This is a preventable surgical complication but not the most common cause of poor function 3
Common Pitfalls to Avoid
- Do not assume all stoma dysfunction is due to surgical technique errors - most cases relate to functional or mechanical obstruction that develops postoperatively 1
- Distinguish between early (ileus) and late (obstruction, hard stool) causes as management differs significantly 1
- Remember that high output is different from poor function - a non-functioning stoma typically has reduced or absent output, while high output represents a different problem entirely 1, 4
Clinical Assessment Priorities
When evaluating a poorly functioning colostomy, specifically assess for:
- Absence or significant reduction in stool output suggesting obstruction or ileus 1
- Stomal stenosis by digital examination or visualization 2
- Signs of bowel obstruction including abdominal distension, pain, and nausea 1
- Consistency of output - hard, formed stool can indicate inadequate hydration or partial obstruction 1