A novel approach to pouching a stomatized fistula

Problem

Fistulas are difficult to manage complications of surgery. Fistulas produce effluent like an ostomy, however they are difficult to pouch. Fistulas within a wound and stomatized fistulas present many different challenges, and wound, ostomy, and continence nurses are looked to for solutions. Patient admitted to a 7 county home care agency in upstate New York. 62 year old female with no significant PMH, had large bowel resection for colonic polyp with ileostomy. Midline surgical incision dehisced and an enteroatmospheric fistula formed. The fistula stomatized and the os pointed downward. Challenges faced: high output stool, leaking appliances, denuded skin that was painful, necessitating narcotics. Approaches that failed included use of barrier rings, stoma paste, medical adhesive spray.

Solution

A novel solution of creating a conduit (“slide”) to guide liquid stool from the fistula into the pouch. The conduit was fashioned by the WOC nurse using materials that were thin and flexible. One end of this “slide” was tucked underneath the fistula, the other end placed into the pouch. Instead of stool weakening the wafer at skin level, stool slid down this conduit, into the pouch. Immediately the patient experienced reduced leaking and two day wear time. We crusted with stoma powder and cyanoacrylate-based monomer. This healed the skin within 1 week, the appliance adhered well, and eliminated the need for narcotics.

Conclusion

Managing a fistula at home can mean frequent leaking, appliance changes, painful skin irritation, social isolation. Using this “slide” allowed for better wear time, increased confidence in socializing, eliminated narcotic use, and better quality of life. In certain clinical cases, if an os points downwards, the “slide” technique might be helpful in directing stool into the pouch, preventing stool from undermining the appliance. The “slide” technique could be used with stomatized fistulas and surgically created fistulas.