Stomal retraction is defined as the disappearance of normal stomal protrusion in line with or below the skin level.2 Retraction is classified as a complication because stomas are easier to manage when they project at an appropriate level above the skin. Maintaining an adequate seal necessary to contain effluent is especially difficult when pouching a retracted stoma. Common causes include problems with surgical construction of the ostomy resulting in mesenteric tension or an inadequate stomal length. Retraction may also be associated with a distended and edematous abdominal wall, early removal of a loop device from a bowel under tension, mucocutaneous separation, or stomal necrosis.8 Peristalsis can also affect the presence or severity of retraction.17
The pouching system is removed to assess the stoma and ascertain the height of the stoma in relation to the peristomal skin. The stoma may not recede while standing, but the degree of retraction may deepen in the sitting or supine position. The stoma may present as a sunken abdominal defect with creasing of the surrounding skin as it is drawn in because of tension. This can lead to pooling of effluent under the pouching system and damaged peristomal skin.