Case Study Location
UK
Patient
34 year old male, mechanic, active.
Medical History
- Initial diagnosis ulcerative colitis; had total colectomy and ileostomy 8 years ago.
- Pouch surgery 6 years ago.
- Reversal of ileostomy 5 years ago.
- Formation of loop ileostomy 3 years ago due to pouch failure and fistula problems.
- Refashioning of ileostomy - conversion from loop to end stoma and stapling over of pouch 2 years ago.
- Now being reinvestigated for possible Crohn's disease.
Product History
Used a 2-piece soft seal - causing pain and sore skin. Unable to bend down because the pain was so severe.
Changed to a different soft convex - pain was much improved but still having area of sore skin around stoma from the 4 o'clock to 8 o'clock positions, and occasional pain.
Using powder, which improved the situation slightly. Pouches only lasting 1-2 days. The patient wanted a longer wear time due to his social life. He regularly camped in a rural site with no facilities and would like not to have to change the pouch so often. He also wished to use a flat 2-piece pouch.
Large granulomas on stoma bleed readily.
Solution
The patient tried Dermacol DC29 and wear time increased to 3-4 days. He has had a pouch for the last 7 days with no skin problems.
Cuts pouch to 30mm; stoma measures 28mm.
The sore area under the stoma was gone in 2 days, with no more pain. He now changes the bag when he wants, rather than when it itches on his skin - which used to happen after 1-2 days.
The patient stopped using convex and has gone back to 2-piece, flat pouches.
Now has less bleeding from granulomas and is much happier. The burning skin has stopped and wear time has increased by 1½ days.