Venous ischemia in a colonic stoma

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

PH Abdomino-perineal resection for low rectal cancer (years ago). Now stoma is not working has developed severe abdominal pain. Stoma is swollen.

Patient Data

Age: 40
Gender: Female

Circumferential edema of the colon as it passes thorugh the muscle of the anterior wall up to the stoma with edema in the surrounding fat. Back-up fecal distension of the colon proximal to the stomal edema.

Case Discussion

The colon is effectively "strangled" as it passes through the abdominal wall musculature causing secondary mural odema and luminal obstruction due to venous obstruction.

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