INTRODUCTION: Diverting colostomies performed for the purpose of fecal diversion in the presence of non-healing sacral/coccyx pressure ulcers may impose a major medical cost. Average charges for a diverting colostomy were $10,000 in our institution. We examined the use of an internal fecal management system* to determine if the need for diverting colostomy could be decreased in those patients who had liquid stool. During the two years prior to the pilot, 10 diverting colostomies were performed for these indications.

OBJECTIVE: To effectively contain and divert fecal waste away from the body in patients who are incontinent of liquid stool to prevent the need for diverting colostomy and promote the healing of wounds.

METHOD: An eight month pilot using a fecal management system was conducted. Criteria for admission were: the presence of a non-healing sacral/coccyx ulcer and indications consistent with those listed in the package insert. All involved nursing personnel were educated on insertion, maintenance and care, and removal of the device. Wound assessments, measurements, and plan for care were developed and monitored by the wound care team.

RESULTS: Four patients met the criteria for inclusion into the pilot and all four were considered for diverting colostomy. Diverting colostomies were avoided in all four instances.

CONCLUSION: The use of a fecal management system can effectively decrease the need for a diverting colostomy in patients with non-healing sacral/coccyx pressure ulcers. An additional benefit included a documented improvement in the condition of their wounds with this system.

*Product Notation Flexi-Seal" Fecal Management System

Flexi-Seal is a registered trademark of E.R. Squibb & Sons, L.L.C.