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Many published studies address quality of life (QOL) among persons living with an ostomy with pouch leakage having the most significant impact. It can contribute to stress, anxiety, depression, a lack of desire to participate in social activities and an inability or lack of willingness to return to normal activities. Difficulty in maintaining a seal between the pouch and the skin also contributes to peristomal skin damage. An irregular stoma or irregular peristomal contours affect adherence of an ostomy pouch leading to leakage.
Ms. J is a thirty-six year-old female with a history of multiple gunshot wounds to the abdomen as the result of domestic violence. Over four years, she endured numerous abdominal surgeries and had frequent hospitalizations. In August 2017, she underwent enterocutaneous fistula removal and creation of an ileostomy. Short bowel syndrome, a high output ileostomy, and an uneven abdominal landscape complicated successful pouching. Over a six month period, in both inpatient and outpatient settings, we tried multiple combinations of pouches and accessory products achieving wear times less than 24 hours. This contributed to frustration and depression. Severely excoriated peristomal skin caused significant pain.
In collaboration with Ms. J, we decided on alginate molding for custom pouching. Within two weeks, we received two sample pouches with a high output tap from the manufacturer. The first pouch lasted three days and required changing due to inadvertent tearing of the pouch by the patient. The patient achieved a seven day wear time with the second pouch and went on to achieve the same results at home. In her words, “the pouch gave me my life back”.
The alginate permitted molding for an accurate depiction of the irregular contours of the pouching surface that could not be described in pictures alone. Custom pouching was life changing for the patient.