What must be ruled out with stoma necrosis?

• A. Stoma stenosis
• B. Melanosis coli from cascara use
• C. Pouchitis
• D. Mucocutaneous separation

Answer: (B)

Stoma necrosis signals compromised tissue viability and prompts careful assessment of what could be causing or mimicking the appearance. Melanosis coli from cascara use is a benign pigment change of the colon mucosa due to chronic stimulant laxative use. When evaluating a stoma with concerning discoloration, it’s important to rule out melanosis coli to ensure that dark coloring around the stoma is not simply a pigment change from laxative use rather than true necrosis of the stoma tissue. The other options describe real stoma-related problems or conditions (stenosis, pouchitis, mucocutaneous separation) that would present with different features and require separate management.