An Adolescent with an Ostomy and Abdominal Pain

Ostomies are created to divert the colon or the small intestine through the abdominal wall. They are performed when a portion of the colon or rectum needs to be bypassed or removed in the management of a variety of pathologic conditions. A parastomal hernia should be considered as a cause of small bowel obstruction in any patient with an ostomy. When a patient with a stoma presents with a fever, the differential includes parastomal infection or parastomal hernia with obstruction. High-output ostomies (>1.5–2 L/day for adolescents and >20–30 ml/kg for infants/children) can cause severe dehydration and electrolyte abnormalities.