A Case Study: Challenges and Management of a Jejunostomy Patient

A Case Study: Challenges and Management of a Jejunostomy Patient

Clinical Problem:

A middle aged male presented with an intraabdominal mass that resulted in three surgeries. He had a small bowel and transverse colon resection followed by a resection of the distal small bowel, right colon and proximal transverse colon. The third surgery resulted in maturation of the jejunostomy. The foreshortened mesentery to the distal portion of the jejunostomy required placement of the jejunostomy in the distal midline incision. There were retention sutures proximal and distal to the elongated vertical stoma and the incision line was concave. Due to the unusual placement of the stoma it became a clinical challenge.

Management:

Immediately post-op a one piece urostomy pouch with a crescent shaped barrier covering the proximal and distal retention sutures was applied. Later, a barrier wafer and a barrier ring were added due to an increase in output. Within 48 hours a trough procedure was accomplished. We were unable to continue the trough procedure due to the high output of up to 6000 mls per day. We then switched to a high output two piece system.  Due to the complexity of the jejunostomy our goal was to make a custom mold and pouch when the retention sutures were discontinued. However, due to the impending patient transfer, a mold was made with retention sutures in place. The custom pouch remained adherent for one week and was in place upon transfer.

Patient Outcomes:

 He continues to care for the jejunostomy independently at home using the custom pouch and maintaining 4-5 day wear time.

Conclusions:

Difficult stomas can be time consuming and mentally challenging. They can quickly deplete your ostomy supplies and overwhelm staff. In many cases it is worthwhile to take the time to have a custom pouch built for your patient.