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Was looking through my old files and stumbled on a list I made a while back while doing my research of possible K-Pouch Complications. I'm sure I may have missed some, so please add on to it and it's management. Best -Mark

  • Early Complications – parastomal hernia, parastomal fistula, nipple valve necrosis, intestinal obstruction, and major bleeding from suture lines (dehiscence). Suture lines dehiscence and valve necrosis both require immediate surgical correction.
  • Late Complications
    • Slipped/Sliding Nipple Valve (Desusception) – stoma comes apart and returns to original state. Results in incontinence WITH intubation difficulties. Requires surgical correction.
    • Nipple Valve Fistula – abnormal opening usually found at or near the base of the valve. Caused by technical problems of valve construction or trauma caused by frequent intubations. Results in incontinence WITHOUT difficulty in intubation. Requires surgical correction.
    • Pouchitis – inflammation of the pouch mucosa. More often related to prolonged periods of intubation and bacterial overgrowth. May cause blood, fever, excessive diarrhea that can overwhelm the valve and cause incontinence. Requires broad-spectrum antibiotics.
    • Nipple Valve Prolapse – caused by fascial defect, which is made to bring out the efferent loop, is too wide. Requires surgical correction.
    • Stenosis – narrowing of the nipple valve caused by development of hypertrophic scars. Can be managed with a baby pacifier or if necessary a procedure called Z-plasty.
    • Pouch Dislocation / Volvulus (twisting) of the pouch - caused by inadequate fixation of the pouch to the abdominal wall, causes intubation difficulties, requires surgical correction.
    • Complete Bowel Obstruction – intubation difficulties, but pouch remains continent. Requires urgent medical assistance.

Resources

- https://books.google.com/books...function&f=false

- https://books.google.com/books...function&f=false

- https://books.google.com/books...problems&f=false

- https://books.google.com/books...%20valve&f=false

- https://books.google.com/books...%20valve&f=false

Original Post

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hi all--excellent list and great explanations with refs.  thanks so much.  also glad you are not having any complications at the moment!!

sharon had also made a list some time back.  perhaps she recalls the post and can include it.

would add hernia adjacent to valve.  in my case it dislocated the valve, which resulted in difficult insertion of the catheter.  the surgery reinforced the area around the hernia, although some surgeons stitch in a mesh around the valve.  

let's all stay well!  janet

Thanks Janet,

What you describe is a peristomal hernia...a hernia close to or right over the stoma area...causes it to no longer be held tight by the muscles and move, twist or bend.

Yes, I made a list and can add a few other here...

1. Pouch slipping off of the wall...happens often post-op, after a trauma or 6 weeks post op when the temp sutures are absorbed (if they use temps) and the pouch is not yet attached to the abdomen...it can slip "off the wall " either totally meaning it is collapsed onto the organs below causing "crushing" as well as a pulling on the valve and incontinence or a valve twist.

When it is partially slipped "off of the wall" it can hang slightly and cause a change in valve trajectory causing difficulty intubating, partial or total incontinence or blockages. 

The danger or both is damage to the valve due to repeated pushing  of the cath in and hitting the wrong part of the valve (makes a painful divot) or hooking the cath on part of the valve.

2. Divots are also a side effect of a change in valve trajectory.

3. Necrosis behind the pouch...between the pouch and the abdominal wall...it can cause high fever, exhaustion, high white count, repeated infected cysts all over the body or in the lymph.

The only thing that can be done is to take down the pouch, clean up the area and then reattach the pouch slightly higher or lower with the possibility of having to move the stoma to another site.

4. Something getting stuck inside of the pouch like undigested pills.  They will need to be removed through scope.

That's all that I can think of for now.

Sharon

 

 

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