© The ASCRS 2018 A 67-year-old woman with a BMI of 44 presents to clinic reporting colostomy dysfunction. She reports bloating and difficulty with pouch adherence. Her ostomy opening seems to have gotten smaller, but she cannot see it because it is below a fold. She passes mostly liquid stool multiple times a day. She had a Hartman procedure 1 year ago that was notable for difficulty making the stoma reach and that, postoperatively, her stoma was dark, but this was managed nonoperatively. On examination, the appliance contains liquid stool and, upon removal, there is no visible ostomy but, instead, puckered skin with an opening that will not admit a Q-tip (Fig. 1). Abdominal films reveal a large amount of stool throughout the colon.