Gastrostomy (G, GJ, J) Complications — Prolapse — Clinical Pathway: Inpatient

G, GJ, J Tube Complications Clinical Pathway — Inpatient

Prolapse

A prolapse of the stoma is when gastric mucosa extrudes/slips forward and is visible on the exterior portion of the skin. This generally is the result of some form of pressure (internal or external) on the stoma, such as:

  • Positive pressure ventilation
  • Tube sizing (layers of multiple dressings that may cause pressure on balloons, size of tube, balloon in the tract)

Patients may not be uncomfortable or in pain with a prolapse.

Differentiating Prolapse from Granulation Tissue

Prolapse can be difficult to identify and differentiate from hypergranulation tissue. Prolapsed gastric mucosa tends to have a beefy red color and velvety, smooth appearance. Granulation tissue tends to be pink or red in color, feels spongy or firm, and looks bumpy. If unsure about prolapse, notify the appropriate service.

Granulation Tissue

Moderate granulation

Prolapse

Severe prolapse
 

Prolapse

Potential Source Recommended Approach Comments
Increased intra-abdominal pressure (e.g., positive pressure ventilation, ascites, obstruction)
  • Notify the FLOC to assess the prolapse.
    Document the site with images in Epic Media tab.
  • New Prolapse: Consult General Surgery for evaluation.
  • Chronic Prolapse: Notify the appropriate service.
  • If unsure about prolapse, notify the appropriate service.
  • Bedside clinicians should not attempt to reduce a prolapsed stoma.
  • Bedside RN or FLOC should not upsize or downsize the tube or replace the tube.
  • Silver nitrate is contraindicated in prolapse.
External pressure on stoma (e.g. tube fit/sizing)

Mild Prolapse

Mild prolapse example 1

Severe Prolapse

Severe prolapse example 1Severe prolapse example 2Severe prolapse example 3