Case Study Location
Australia.
Patient
Mr R is a 64 year old male.
Before Dermacol
Mr R underwent an ultra-low anterior resection and loop ileostomy formation for rectal cancer.
Post operatively, he had no pouching or peristomal skin problems and had been managing his stoma care well.
Following his second cycle of adjuvant chemotherapy, he began experiencing pouching problems due to moderately severe mucosititis of the stoma. He was referred to the Stoma Therapy Nurse for review and management by the medical oncologist.
On examination, Mr R's output was 'porridge like' in consistency. His stoma was mildly oedematous, spouting 2cm at the proximal limb. Due to the mucositis, any handling of the stoma caused bleeding of the mucosa which Mr R described as difficult to stop and making pouch application 'impossible' because the volume of blood caused leakage almost immediately. He had tried both a one-and two-piece pouching system prior to Stoma Care Nurse review, in an attempt to improve the seal and wear time. The peristomal skin was in good condition and the abdominal plane suitable for a flat base. The length of stomal protrusion did not change with observed peristaltic action.
Reasons for using Dermacol
Dermacol was recommended for 2 reasons: the soft collar protects the delicate mucosa from accidental trauma during application of the stoma pouch, reducing bleeding volume; and because the base of the Dermacol collar has hydrocolloid around it - this enables the adhesive on the pouch to be cut out slightly
larger, further reducing potential trauma to the stomal mucosa during application.
Results
Mr R's pouch wear time increased from a maximum of 24 hours to 72 hours, and the use of Dermacol reduced trauma and bleeding to stomal mucosa due to decreased frequency of pouch change, while maintaining the integrity of the peristomal skin.