case studies

Case Studies

Case 1

Mr R is a 64 year old male. He underwent an ultra-low anterior resection and loop ileostomy formation for rectal cancer. Following his second cycle of adjuvant chemotherapy, he began experiencing pouching problems due to moderately severe mucosititis of the stoma. He went to visit his NT nurse with complaints from:

  • Flange not staying
  • Blood with the stool
  • When he changed the appliance and he touched the stoma it started bleeding
  • He felt that the stoma looked bigger

Diagnosis: Mucosititis
Management:

  • Cut the flange bigger
  • Dry the surrounded stoma area good
  • Use the stoma paste
  • Use stoma powder for the macerated area
  • Follow the steps of application

Case 2

A 56-year-old, obese male was admitted with rectal cancer. He underwent a low abdominal resection that resulted in a temporary loop ileostomy. He also had a history of diabetes and hypertension. The patient was not preoperatively sited or marked. The stoma was located in a deep abdominal skin fold, which was even more evident when the patient was sitting. This location created:

  • Leaks and consequent skin erosion
  • Pain
  • The need for frequent pouch changes
  • Increased cost associated with care

Diagnosis: Stoma with the skin fold
Management:

  • Changing appliance while lying down
  • Filing the space with stoma paste
  • Use stoma powder if needed
  • Follow the steps of application

Case 3

Four years ago, a 65 year old lady has an anterior resection and loop ileostomy for diverticular disease. She was unable to have a reversal of her loop ileostomy, but it was converted to an end ileostomy and she complains from three major things:

  • Burning sensation on the surrounded stoma skin
  • Leakages
  • Loss of confidence

Diagnosis: Under stoma leakage
Management:

  • Drying the surrounded stoma skin well
  • Use stoma powder for the surrounded stoma skin area
  • Follow the steps of application

Case 4

13 year old, young girl had a subtotal colostomy for ulcerative colitis. She complained that she had a pain in the area around the stoma all the time when she removes the stoma belt.

Diagnosis: Pressure ulcer
Management:


Case 5

Mr. T has a colostomy surgery 2 years ago. He came to the ER complaining from:

  • A bad itching in the area around the stoma
  • When examining Mr T, peristomal skin was red and painful
  • And he asks “Is it because I shaved my hair before application?”

Diagnosis: Folliculitis
Management:

  • Clean the surrounded stoma skin area well and dry it
  • Use stoma powder
  • Follow the steps of application

Case 6

Mr. S had a heart attack was taken to the ICU. Mr. S had to have a colostomy 5 years before and dealt with it in a very good way. When the nurse wanted to change his stoma appliance, she found that the skin around the stoma was stuck to the stoma.

Diagnosis: Stoma with the skin fold
Management:

  • Changing appliance when the patient in supine position
  • Filing the spacee with stoma paste
  • Use stoma powder if needed
  • Follow the steps of application

Case 7

63 year old male complains of ulcerative colitis 3 months after Colostomy surgery. Patient complains of:

  • Flange does not stay in place for more than 6 hours
  • Leakage under the flange
  • Some burning sensation around the stoma
  • When he looks to the stoma he feels that it is going down

Diagnosis: Flush stoma
Management:

  • Change to a convex barrier
  • Cleans the surrounded stoma skin aria well and dry it
  • Use stoma powder
  • Filing the space with stoma paste
  • Follow the steps of application