Treatment of Stomal Prolapse Using Epidural Block and Hyperosmosis：A Case Report

Abstract

A woman in her 40s who had been receiving chemotherapy for cervical cancer underwent potentially curative surgery. However, a bicornuate aperture stoma was constructed because of a rapid increase in the size of the tumor. The patient developed mucosal edema of the stoma with venous return disorder 2 days later, and we enlarged the fascial hole and reconstructed a stoma at the same site. The patient’s intestinal edema improved and she was initiated on chemoradiotherapy; however, progressively worsening mucosal edema developed on day 25 after artificial anal re-construction. Manual reduction was difficult due to the pain, and palliative care was initiated for pain relief. In joint consultation with the Department of Surgery, we planned to improve the patient’s mucosal edema by reducing the osmotic pressure, together with analgesia and muscle relaxation. We administered epidural analgesia with 5 mL of 2％ lidocaine injected via a peridural catheter, and sprayed 10 g of glucose on the edematous intestinal mucosa. With this treatment, the intestinal edema improved and the anal protuberance could be reduced manually.