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Discussion

Please help with a difficult ostomy

My client has had an ostomy for a few years, developed a hernia but could not have any further surgery done...last year she developed Umbilical Ca with mets to abd wall....she received a course of radiation followed by chemotherapy....her stoma was 1 1/4 "...then reduced to 1 1/8 ' then to 1" with the chemo...The problem is the inferior aspect of the stoma is smaller than the superior asp....making the opening face downwards and causing leakage.... now we have an ulcer to the peristomal tissue at the medial asp....the leakage starts at about the 7 oclock position...we have had the ET visit and none of her suggestions have worked...with the chemo, the client often has to change the wafer 3x/24hrs.... even when the diarrhea is under control with anti-diarrheals, the soft pasty stool pushes under the rim......at this point, ET and 4 different nurses have tried to come up with a way to prevent the stool from leaking under the wafer and onto the ulcer...

any suggestions would be greatly appreciated ....

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    Hmm...I've had a pt have their stoma dilated, then a Bard catheter inserted in the stoma to facilitate drainage...intermittent irrigation with low suction at 10mm...use of urostomy bag attached to suction...pt had several problems with stoma, including medial stoma irritation. Pt was obese. Stopped the leakage.

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    It would be easier to offer up suggestions if I knew what you already tried/what products you tried/how you are treating the ulcer????

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    Stoma revision? If that is now possible..Is there an uneven area that is making the appliance not lay flat? Was there less leakage with thinner stools? Hard to say with what info you have given us. In the meantime you probably already are using a skin prep to make a barrier to keep the skin from having stool irritate it??

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    Have you tried Cymed? They have a novel, appliance that adheres to the skin with a tegaderm-type material. Because it is so thin, stool cant easily leak underneath. You can see them at http://www.cymedostomy.com/what.html. The company is very generous with samples. The ulcer can be protected with Arglaes powder. Brush off excess with dry gauze before attaching appliance.

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    • Author

    Thanks for the suggestions ...I did email the Cymed Co and samples are on the way...

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    There is an ostomy adhesive, when properly applied to bothe surfaces and left to get tacky will do the trick.

    Good luck.

    LJ Russell LPNWCC

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