What can cause an ostomy to have no output?

Causes of No Ostomy Output

No output from an ostomy represents a surgical emergency requiring immediate evaluation for bowel obstruction, stomal stenosis, or nonfunctioning stoma, as these conditions can lead to bowel ischemia and perforation if not promptly addressed.

Immediate Life-Threatening Causes

Small Bowel Obstruction at the Stoma Site

• SBO is common and occurs specifically at the stoma site, requiring urgent intervention 1
• Trans-stomal decompression is the most effective initial management for obstruction at the stoma level 1
• Obstruction can result from adhesions, internal herniation, or stomal complications 2

Stomal Stenosis

• Stenosis causes narrowing of the stomal opening, preventing passage of stool 1
• This complication typically develops over time but can present acutely with complete obstruction 3
• Digital examination of the stoma can identify tight stenosis requiring surgical revision 4

Nonfunctioning Stoma

• Nonfunctioning stoma occurs in 11.9% of ileostomy patients and represents a significant complication requiring immediate attention 3
• This can result from technical issues during stoma creation or early postoperative complications 3

Early Postoperative Causes

Stomal Ischemia/Necrosis

• Ischemia occurs due to insufficient arterial blood supply to the stoma 1
• Necrosis should be assessed on the first postoperative day, as it represents an early complication 3
• Complete necrosis can lead to stomal retraction and loss of function 1

Postoperative Ileus

• Ileus should be promptly evaluated in the context of no ostomy output, particularly in colostomy patients where this is unusual 5
• Infection (postoperative abdominal infection or Clostridioides difficile) must be ruled out as a cause of ileus 5
• Medication-related adverse effects can contribute to decreased motility 5

Stomal Retraction

• Retraction is seen in patients with bulky mesentery and occurs following ischemia 1
• Retracted stomas may become flush with the skin or sink below skin level, potentially obstructing output 1
• Assessment should occur on the seventh postoperative day 3

Mechanical Complications

Stomal Prolapse with Incarceration

• Prolapse is a full-thickness protrusion that can become incarcerated, causing obstruction 1
• Incarcerated hernia is a surgical emergency leading to obstruction and eventual bowel ischemia 5
• Manual reduction should be attempted initially, but emergency bowel resection may be needed for incarcerated cases 1

Parastomal Hernia with Obstruction

• Parastomal hernia occurs in up to 50% of ostomates within 5 years 5
• When incarcerated, these hernias cause painful obstruction that cannot be reduced 5
• Surgery is considered in cases of incarceration causing complete obstruction 1

Critical Pitfalls to Avoid

• Do not assume absence of output is normal in the early postoperative period - this warrants immediate investigation for obstruction or technical failure 5
• Distinguish between true absence of output versus high-output states, as management differs completely 5, 6
• In loop ostomies, ensure you are examining the correct (proximal/active) limb, as the distal limb normally has minimal output 5
• For continent ileostomies (Kock pouch), absence of spontaneous output may be normal as these require catheter intubation 5

Immediate Evaluation Steps

• Perform digital examination of the stoma to assess for stenosis or obstruction at the mucocutaneous junction 4
• Examine the stoma for color changes indicating ischemia (dusky, dark, or black appearance) 3
• Assess for incarcerated parastomal hernia with inability to reduce the hernia manually 5
• Obtain imaging (CT scan) to evaluate for internal obstruction, particularly at the fascial level 2
• Check for signs of peritonitis suggesting perforation or anastomotic leak 2