Juggling management of stool containment and healing of a severe peristomal wound

Introduction: An extensive full thickness wound with a well budded ileostomy, stranded as a midwound island, presented a challenge for the WOCRN. This poster presentation will follow the progression of this wound, the innovative pouching system utilized to contain effluent, wound treatment and ultimately healing.

Clinical problem: 63 year old female with Chronic Ulcerative Colitis, high dose steroids, and history of CMV colitis underwent Subtotal Colectomy with end ileostomy. She was dismissed POD3 without complications. Two days later she presented to local ER with redness, fever and wound drainage. She was started on oral antibiotics and sent home. Six days later, she was admitted with boggy peristomal skin and expanding cellulitis that measured 15cm by 9cm. The ileostomy appeared healthy stranded in the middle of the developing wound. The peristomal skin progressed to black necrotic tissue. Within a few days, with autolytic debridement, the wound developed into a deep full thickness wound with deep tunneling around the stoma and towards the midline incision. The wound was packed with moist gauze and covered with pink foam which was used to absorb moisture, sooth and cleanse the tender wound edges enhancing patient comfort. There was not an intact surface upon which to pouch. The ostomy effluent was contained with a nonadhesive convex pouching system secured with hernia support belt. The patient received a few days of IV antibiotics, the steroids were further tapered and following complete autolytic debridement, the wound began to heal.

Conclusion: We were able to provide effective wound care, adequately contain ostomy effluent and subsequently teach the patient and husband wound and ostomy care. They returned home to achieve complete wound healing and recuperate safely. Though each patient's situation is unique, this non invasive wound treatment and ileostomy containment method could be used with other patients in a similar situation.