Which of the following is NOT a contributing factor to stoma necrosis?

• A. Atherosclerosis
• B. Obesity
• C. Hypotension/hypovolemia
• D. Edema of bowel wall

Answer: (A)

Stomal necrosis happens when the tissue that forms the stoma doesn’t get enough blood and oxygen to stay viable. The stoma relies on adequate arterial inflow through the mesentery and good venous drainage; anything that lowers perfusion or increases tissue pressure can push it toward ischemia.

Low blood pressure or reduced circulating volume around the time of or after surgery reduces the driving force pushing blood into the stoma, so the tissue becomes ischemic and may necrose.

Edema of the bowel wall raises interstitial pressure within the stoma tissue, which can compress tiny vessels and further cut off microcirculation, promoting necrosis.

Obesity increases the risk because excess abdominal fat can raise intra-abdominal pressure and create tension or distortion of the vessels feeding the stoma, compromising blood flow and healing.

Atherosclerosis, while a systemic vascular disease, is not considered a direct, acute contributor to stomal necrosis in this context; the immediate issues are perfusion-related factors like hypotension, edema, and tissue tension.