Stoma

Understanding Stoma and the Legal Implications of Medical Malpractice

A stoma is surgically created opening in the abdomen that allows waste (urine or feces) to leave the body when the normal path is blocked or damaged, and it can be needed following medical malpractice. The word “stoma” comes from the Greek word for “mouth,” and in a medical context, it involves bringing a piece of the intestine or ureter to the surface of the skin.

While stomas are often life-saving procedures, they represent a massive lifestyle change. When a stoma is required not because of a natural disease progression, but because of a surgical error or a misdiagnosis, it may be the basis for a medical malpractice lawsuit.

1. Colostomy: The Large Intestine Stoma & Medical Malpractice

Anatomy and Function

A colostomy involves the large intestine (colon). The surgeon brings a portion of the colon through the abdominal wall. Waste passes through this opening into a disposable pouch attached to the skin. Because it involves the large intestine, the output is typically firm or formed, similar to a normal bowel movement.

Reasons for this Procedure

Common reasons include colon cancer, diverticulitis, traumatic injury to the abdomen, or congenital defects.

The Procedure and Medical Specialist

Colostomies are performed by Colorectal Surgeons or General Surgeons. During the procedure, the surgeon identifies the healthy portion of the colon, creates a circular incision in the abdominal wall, pulls the colon through, and sutures it to the skin to create a “bud.”

Permanence

Colostomies can be temporary (to allow the lower bowel to heal after surgery or injury) or permanent (if the rectum or lower colon must be removed entirely).

Stoma Medical Malpractice and Colostomies

A colostomy becomes a malpractice issue when it is “avoidable.” This typically happens in two ways:

• Surgical Error during a different procedure: If a surgeon accidentally perforates the bowel during a routine gallbladder surgery or hysterectomy and fails to notice it, the bowel injury may result in infection (peritonitis) and require an emergency colostomy to save the patient’s life.
• Failure to Diagnose: If a doctor ignores signs of colon cancer or severe diverticulitis until the bowel ruptures, a permanent colostomy may be required, whereas early intervention might have saved the bowel.

Common Claims: Failure to monitor post-operative infection, “nicked” bowel during unrelated surgery, and delayed diagnosis of colorectal disease.

2. Ileostomy: The Small Intestine Stoma

Anatomy and Function

An ileostomy involves the ileum, which is the lowest part of the small intestine. Because the waste exits before it reaches the large intestine (where water is absorbed), the output is usually liquid or paste-like and contains digestive enzymes that can be very irritating to the skin.

Reasons for this Procedure

This is often for patients with Crohn’s Disease, Ulcerative Colitis, or Familial Adenomatous Polyposis (FAP). It is also used when the entire large intestine must be removed.

The Procedure and Medical Specialist

Performed by a Colorectal Surgeon. The surgeon loops the end of the small intestine through an opening in the lower right side of the abdomen.

Permanence

Like colostomies, these can be temporary (to rest the colon) or permanent (if the doctor removes the colon and rectum).

Stoma Medical Malpractice and Ileostomies

The most common malpractice claims regarding ileostomies involve surgical technique and informed consent.

• Improper Placement: If a surgeon places the stoma in a skin fold or too close to the hip bone, the pouch will not seal properly. This leads to constant leaking of caustic digestive enzymes, causing severe chemical burns and skin breakdown (excoriation). This may require “revision surgery.”
• Bowel Ischemia: If the surgeon cuts off the blood supply to the stoma during the procedure, the tissue will die (necrosis), requiring emergency re-operation.

Common Claims: Negligent stoma site selection, failure to recognize stoma necrosis, and unnecessary total proctocolectomy due to misdiagnosis.

3. Urostomy: The Urinary Stoma

Anatomy and Function

A urostomy diverts urine away from a diseased or damaged bladder. The most common type is an Ileal Conduit. The surgeon detaches the ureters (the tubes that carry urine from the kidneys) and attaches them to a short section of the small intestine. The doctor repurposes this as a pipeline. The doctor then brings one end of this pipeline through the abdominal wall to create the stoma.

Reasons for this Procedure

The primary reason is bladder cancer. The doctor may also perform it for severe interstitial cystitis or spinal cord injuries that prevent the bladder from functioning.

The Procedure and Medical Specialist

A Urologist or a Urologic Oncologist performs this procedure. It is a complex surgery involving both the urinary and digestive tracts.

Permanence

Urostomies are almost always permanent, as the doctor usually removes the bladder (cystectomy) during the process.

Stoma Medical Malpractice and Urostomies

Urostomy-related malpractice often centers on the failure to manage complications:

• Ureteral Strictures: If the surgeon performs a negligent “anastomosis” (the connection between the ureters and the intestinal conduit), scarring can block the flow of urine. This causes urine to back up into the kidneys (hydronephrosis), leading to permanent kidney failure.
• Failure to Diagnose Bladder Cancer: If a urologist fails to investigate blood in the urine (hematuria) in a timely manner, the cancer may progress to the point where the bladder cannot be saved, necessitating a urostomy that could have been avoided with early treatment.

Common Claims: Medical negligence leading to kidney failure, failure to diagnose bladder cancer, and leakage of urine into the abdominal cavity (uroperitoneum) due to poor suturing.

Legal Theories in Stoma Medical Malpractice Cases

To prevail in a medical malpractice claim involving a stoma, a plaintiff must prove four elements: Duty, Breach, Causation, and Damages.

1. Standard of Care (Breach): A medical expert witness (usually another surgeon) must testify that the defendant doctor acted in a way that a reasonably competent doctor would not have. For example, failing to check for bowel leaks before closing a patient.
2. Causation: You must prove that error resulted in the need for the stoma. If a patient had Stage 4 cancer and would have needed a stoma anyway, the doctor might not be liable even if they made a minor error. However, if a routine colonoscopy results in a perforated bowel that requires a stoma, causation is clear.
3. Damages: The “damages” in stoma cases are often high. They include the cost of lifelong medical supplies (pouches, barriers), the pain of skin infections, the psychological impact of body image changes, and the cost of reversal or revision surgeries.

Conclusion on Stoma & Medical Malpractice

A stoma is a significant life event. When it is the result of a surgeon’s steady hand and a necessary treatment, it is a tool for survival. However, when it is the result of a “nicked” organ, a missed diagnosis, or a surgical blunder, it can be a life-altering injury that warrants legal investigation. Due to the high expense and lengthy litigation process, we are usually only able to investigate a medical malpractice case when the stoma is permanent.

If you have any concerns or questions about a stoma and medical malpractice, then visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.