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Colostomy infection — Clinical Guidelines

Overview

Colostomy infection refers to complications involving microbial contamination at the site of a colostomy, potentially leading to surgical site infections (SSI) and other related issues such as anastomotic leakage and prolapse. 1

Diagnosis

Clinical signs include redness, swelling, discharge, and pain at the stoma site.

Laboratory tests may include wound cultures to identify pathogens.

Imaging is not typically required unless complications like abscess formation are suspected.

Management

Antibiotics: Consider empirical antibiotic therapy based on local resistance patterns and wound culture results. 1

Wound care: Regular cleaning and dressing changes to maintain a sterile environment.

Stoma site management: Proper fitting of appliances and regular assessment by stoma care nurses to prevent complications. 2

Surgical intervention: May be necessary for deep infections, anastomotic leaks, or recurrent prolapse. 5 8

Special Populations

Pediatrics: Colostomy closure without mechanical bowel preparation (MBP) appears safe and non-inferior in terms of complications like SSI compared to procedures with MBP. (Evidence: Moderate) 1

Comorbidities: Regional anesthesia and sedation can be effectively used in high-risk patients, such as those with pulmonary embolism or supraventricular tachycardia, to perform colostomy revisions safely. (Evidence: Weak) 4

Key Recommendations

Consider omitting mechanical bowel preparation before colostomy closure in pediatric patients to avoid potential adverse effects without increasing surgical site infection risk. (Evidence: Moderate) 1

Utilize regional anesthesia and sedation techniques for colostomy revisions in patients at high risk for general anesthesia complications. (Evidence: Weak) 4

Employ minimally invasive techniques, such as endoscopic assistance, for colostomy creation in critically ill patients to minimize morbidity associated with general anesthesia and laparotomy. (Evidence: Moderate) 6

References

1 Fernandez-Portilla E, Davila-Perez R, Nieto-Zermeño J, Zalles-Vidal C, Abello-Vaamonde JA, Dominguez-Muñoz A et al.. Is colostomy closure without mechanical bowel preparation safe in pediatric patients? A randomized clinical trial. Journal of pediatric surgery 2023. link 2 McGrath A. Stoma-associated problems: the important role of the specialist nurse. British journal of nursing (Mark Allen Publishing) 2017. link 3 Wright Z. Returning to the gym with a stoma: a patient's perspective. British journal of nursing (Mark Allen Publishing) 2017. link 4 Ng O, Thong SY, Chia CS, Teo MC. Revision of loop colostomy under regional anaesthesia and sedation. Singapore medical journal 2015. link 5 Arenal JJ, Tinoco C, Benito C, Citores MA, Visa J. Correction of distal limb prolapse of a diverting colostomy by stapling under sedation. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 2012. link 6 Mattingly M, Wasvary H, Sacksner J, Deshmukh G, Kadro O. Minimally invasive, endoscopically assisted colostomy can be performed without general anesthesia or laparotomy. Diseases of the colon and rectum 2003. link 7 Hebert JC. A simple method for preventing retraction of an end colostomy. Diseases of the colon and rectum 1988. link 8 Krasna IH. A simple purse string suture technique for treatment of colostomy prolapse and intussusception. Journal of pediatric surgery 1979. link80269-9)

Colostomy infection