Nursing Management of Transverse Colostomy located on the Incisional Wound

Background : A male patient of 52 years-old, diagnosed sigmoid cancer with Hartmann’s procedure and reversal done on year 2004. Afterwards, he suffered anastomosis recurrence and carcinomatosis, multiple operations were done. This time, he was acutely admitted due to intestinal obstruction. Then he underwent an emergency operation laparotomy, repair of small bowel perforation and transverse loop colostomy. Because of the short mesentery, grossly distended small bowel, transverse and descending colon, transverse loop colostomy was performed and fashioned at upper midline wound. The stoma was anchored with suction catheter instead of stoma plastic rod.

Immediate Postoperative Care : Apart from standard post-operative care for general anesthesia and abdominal surgery. Maintain secure sealing of stoma pouch was important to prevent fecal soiling on the incision line causing the risk of surgical site infection. As the new stoma (loop transverse colostomy) located on the upper end of abdominal wound, we should observe the viability of stoma/ any sudden retraction of stoma resulting from complication of short gut and short mesentery. Meanwhile, it was also required to monitor closely for any tension/compression on the stoma caused by supporting catheter.

Discharge Planning and Stoma Care Education : On post op D14, sutures were removed with good union without any wound dehiscence. Since patient had previous experience of self stoma care for end-colostomy, patient education just focused on peristomal skin care.

Conclusion : For immediate post-operative period, close monitoring was necessary to identify any stoma/ peristomal complications and treated promptly. In view of the flush stoma located on upper end of abdominal wound and near xiphoid process, specific consideration on stoma management can be challenging.