Stomal prolapse is defined as a telescoping of intestine through the stoma.2 It is particularly prevalent in loop transverse colostomies and typically associated with a large opening in the abdominal wall, insufficient attachment of the bowel to the abdominal wall, insufficient fascial support, or increased abdominal pressure such as when children cry and cough.8 The prolapse can vary in length from 5 to 13 inches as it extends into the pouch.11 The affected bowel tends to be edematous from the dependent prolapse, easily traumatized, and prone to bleed.
The stoma is assessed for the degree of bowel protrusion, mucosal irritation, and color. On occasion, an acute prolapse can exert excessive tension on the mesentery, resulting in an obstructed stoma.8 Stomal viability must be carefully monitored since blood flow can be compromised resulting in an ischemic stoma that appears dark, dusky, purple, or pallid.17