Stomal Outlet Obstruction Caused by Torsion of the Stomal Limb Associated with Fecal Loading after End Colostomy: A Case Report.

INTRODUCTION: Stoma-related complications after colostomy include obstruction, prolapse, and parastomal hernia. However, torsion of the stomal limb associated with fecal loading in the proximal colon has rarely been reported. CASE PRESENTATION: A 55-year-old woman with a history of rectal cancer underwent multiple surgeries, including pelvic exenteration with a permanent end colostomy via an intraperitoneal route. Nine days after discharge following hepatectomy and inguinal lymph node dissection, she presented with abdominal pain and cessation of stool output. CT revealed obstruction at the stomal outlet. Decompression through the stoma using a drainage tube was attempted but failed. Emergency surgery was performed. Intraoperatively, no significant adhesions were observed. The proximal colon was markedly dilated and filled with feces. An elongated transverse colon and a mobilized splenic flexure had descended into the pelvis, and the fecal loading may have contributed to torsion of the stomal limb at the outlet. Reduction of the colon from the pelvis resolved the torsion. Fecal contents were evacuated via the stoma, and no bowel resection was required. The postoperative course was uneventful, and the patient was discharged on the 5th day after surgery. No recurrence was observed during the short-term follow-up. CONCLUSIONS: Torsion of a mobile stomal limb associated with fecal loading should be considered as a rare cause of stomal outlet obstruction, particularly when conservative decompression is ineffective. In patients with an elongated and mobile colon, appropriate bowel management may be important to prevent fecal retention and recurrence.