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Stoma retraction case study

The ideal stoma protrudes above the skin, but in some cases, it can also retract for different reasons and it can be difficult to get a good seal around a retracted stoma, causing leakage and subsequent irritation Skin, so daily care and selection of suitable products are also very important. Suitable products can increase the adhesion of the stoma bag and minimize the risk of stoma leakage. Let's take a look at a stoma retraction case, and follow me to see how to deal with and prevent it.
The picture below is the photo taken by Ms. Zhong last week


Patient's self-report: the skin around the stoma was broken.

Conclusion: From the picture above, it can be seen that the stoma is parallel to the skin level, and a low stoma will cause excrement leakage, which will lead to fecal water dermatitis in the surrounding skin lesions, and will also increase the difficulty of wearing the stoma bag.

What is the reason for this?

a. Insufficient free bowel length

b. The mesentery is too short to generate pulling force

c. Insufficient suture fixation around the stoma or premature detachment of the suture

d. Poor healing around the stoma

e. Excessive weight gain after surgery

How should stoma retraction be cared for?

a. For light ones, it can be fixed with a two-piece convex chassis and a belt

b. Lose and control weight

c. Those with damaged skin should take appropriate skin care.

Precaution:

a. Surgical factors: retain enough intestinal segments to reduce intestinal tension;

b. Maintain good blood supply: strengthen the observation of stoma blood supply, especially within 24 to 48 hours after operation;

c. Maintain a reasonable weight: avoid rapid weight gain in a short period of time;

d. Unsatisfactory stoma: If the stoma is below 1cm below the skin level, a raised appliance should be used together with a stoma belt or a stoma belt;



Treatment measures: depends on the degree of retraction

a. For those with mild retraction and the opening of the intestinal end located outside the fascia, pay close attention to the progress of stoma retraction; use the convex chassis and belt together.

b. In severe cases retracted into the abdominal cavity, surgery should be performed immediately to deal with peritoneal inflammation and reconstruct the stoma. For those with late retraction, some scholars believe that the colostomy is not easy to propose because of the intestinal segment, and a laparotomy is required to free the intestinal segment in the abdominal cavity before performing the colostomy.

c. with irritant dermatitis, available skin protection powder, or painless protective film.

d. For those with persistent skin damage at the sigmoid colostomy, colostomy lavage may be considered to remove feces in the colon according to the doctor's advice.

Options for a low-profile or retracting stoma:

It is advisable to choose a raised stoma appliance, such as an Ostomy Skin Barrier Convex, which pressurizes the skin around the stoma to bulge the base of the stoma to facilitate excrement discharge: if the stoma is not in a good position, it is not suitable to use a convex bottom plate Locally use Anti-leakage Strip to increase the height; it can be used with the stoma belt to increase the pressure on the base of the stoma.

In particular, it is pointed out that patients with liver cirrhosis and peritoneal effusion cannot use elevated products. Such patients often cause abdominal microvascular varicose veins due to excessive venous pressure. At this time, abdominal microvascular and skin are very fragile, and the pressure ring of the convex stoma chassis Excessive pressure on the skin around the enterostomy can easily cause skin damage, and even compress the microvessels in the abdomen, resulting in ulceration of the skin around the enterostomy. At this time, a one-piece flat ostomy bag should be used together with a skin protective film for treatment.

For more information on Innomed® ostomy attachment refer to the previous articles. If you have customized needs, you are welcome to contact us; we will serve you wholeheartedly.

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Editor: kiki Jia

Date: November 25, 2022