Paris Here we come: Helping an Ostomates Wish

Case

Patient had multiple bowel obstructions and surgeries resulting in short gut syndrome from a different facility. Patient had very poor quality of life due to frequent pouch changes (< 1 hour) from a poorly functioning/ stenosed jejunostomy. Patient used multiple types/brands of pouches with no success. Patient stayed at home due to fear of leaking, depression, and fatigue. Patient decided to undergo another surgery to revise her jejunostomy. Initial meeting revealed a recessed stoma and a surgical incision at risk of dehiscence. Eventually, patient’s surgical incision dehisced and her jejunostomy retracted down. Multiple attempts to pouch the jejunostomy with surgical packing failed to produce desired result.

Solution

Use of compressible isolation device, NPWT with a pouching system for patient’s jejunostomy and dehisced wound assisted in controlling & isolating patient’s effluent. It helped in decreasing the wound surface area. Once this strategy was no longer appropriate, wound pouch with low wall suction was used. Upon discharge to home, patient continued with Wound pouching system without suction, providing her 1-2 days wear time. Once jejunostomy matured, slight peristomal irritation was still noted. WOC RN team decided to custom mold the stoma to create a customized pouch. This helped clear the peristomal irritation and provided 4-5 days wear time.

Conclusions:

Jejunostomy requires a high output pouch that fits appropriately to allow adequate wear time and prevent peristomal irritation. Use of compressible isolation device with NPWT & an ostomy pouch is an approach in treating a dehisced wound surrounding an ostomy. Family support is greatly needed for patients with complex ostomy care needs. Creating a custom mold for a patient’s jejunostomy with an unusual abdominal topography allowed her to have the freedom and a quality of life that she desired even going to a European vacation.