Need Ostomy help please...Ileostomy? Colostomy? Can patients have both?

Specialties Wound

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Specializes in OB, M/S, HH, Medical Imaging RN.

I admitted a patient in HH who has a new colostomy. His hx states that 3 years ago he had an ileostomy. His son is the primary CG. I asked him if they had any trouble with the ileostomy and if it was draining much. He said yes a little but no not having any trouble with it. When I assessed his abdomen I saw and examined the new colostomy, I did not see a ileostomy? He had a small opening in the RLQ just a couple of inches above the colostomy that was covered with a 2x2. I took it off to look. The son said that's where he had a drain in. Ok...so what happened to the ileostomy?

I saw nothing else on his entire abdomen. By the time I wanted to ask the son about it he had left. This pt is brand new in the NH so no one there would have known anything. Opinions Please???? Thanks so much!

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Sounds like recently, the pt had a recurrance of his colon cancer, the ileo was closed, and new colostomy required to be placed. The small RLQ drain site was probably from a jp drain, placed during surgery, and removed at discharge. They (jp drains) collect surgical drainage, and are not permanent.

Some ostomies are temporary, and then are reversed (some rectal cancers, pt has ostomy until the rectum has healed). usually the ones that are reversed are reversed sooner than 3 years, which is why I am thinking recurrance of coloncancer, in new site.

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Specializes in OB, M/S, HH, Medical Imaging RN.

Both ileostomy/colostomy due to Crohn's Disease. The drain site is larger than a JP site. I'm thinking the colostomy is in the same area where the ileostomy used to be because he definately doesn't have both. There are ileostomies that don't use an appliance, the patient uses a small dressing covering it to collect mucous. I don't think that's what the drain site is as it looks like a puncture wound not a stoma.

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Could it be a mucous fistula? I work for a colorectal surgeon and we have a couple of patients that have them.

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Specializes in LTAC, Telemetry, Thoracic Surgery, ED.

I currently have a patient with both. He had a colon resection. The ileostomy drains copious amounts and the colostomy drains nothing. I'm a fairly new nurse so I don't know how often it is that a patient would have both.

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Specializes in med-surg/or/ambulatory/geriatric psyc.

could the place where the four by four was be an opening to a Kock pouch? Does it need to be catherized?

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maybe the dressing was covering the old ileostomy site and the new colostomy was placed above it. they don't always use the same site when moving ostomies around due to scarring.

-sorry! i answered an old post!

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Specializes in med-surg/or/ambulatory/geriatric psyc.

could the place where the 4x4 is be a second ostomy (such as from a double ostomy for draining mucous)? I know that when the rectum and orifice is sewn shut, a second opening is needed for the mucous drainage that the "left-over" intestines need as they still produce mucous.

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Specializes in med-surg/or/ambulatory/geriatric psyc.
could the place where the 4x4 is be a second ostomy (such as from a double ostomy for draining mucous)? I know that when the rectum and orifice is sewn shut, a second opening is needed for the mucous drainage that the "left-over" intestines need as they still produce mucous.

i forgot to mention that i have a colostomy, but i still have an anal opening that i produce "mucous plugs" out of. if the anal opening is closed off, then a double barrel ostomy is made so that one opening produces the feces from the all attached intestines, and the second opening produces mucous from the part of colon or intestines that is no longer used for fecal production. what does this patient have a colostomy for?

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