Intestinal Stomas - Complications, Prevention and Management: Our Experience in Tertiary Hospital

INTRODUCTION: A stoma is defined as an opening into a hollow viscus either natural or surgically created which connects a portion of body cavity to the external environment[1]. Ileostomy or colostomy creation is a crucial part of numerous surgical procedures carried out for a variety of gastrointestinal problems. Despite the frequent occurrence of intestinal stomas, stoma-related problems are still frequent and are associated with high morbidity and expense. OBJECTIVE: The objective if this article is to understand these frequent issues, go into depth about how to prevent or avoid them, and provide management advice. METHOD: Prospective RESULTS: Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. CONCLUSIONS: Ileostomy and colostomy forms are frequently done procedures, but sadly they are linked to high morbidity and stoma-related complication rates that range from 21 to 70%. It has been demonstrated that preoperative entero-stomal therapy consultation and stoma site labelling by either an entero-stomal therapist or skilled surgeon lessen postoperative problems. In addition, it is crucial to pay close attention to the technical aspects of stoma production. In order to definitively address concerns concerning the optimal trephine size, the use of prophylactic mesh, and other aspects of stoma creation, additional randomized trials are required. Clinical wound ostomy nurse specialists are extremely helpful following surgery, and the use of standardized protocols has further helped to reduce the frequency of common problems and readmissions for dehydration.

Mucormicosis periostomal posoperatoria, a propósito de un caso / Mucormycosis periostomal: case report

Resumen Introducción: La mucormicosis en una enfermedad infrecuente y oportunista que afecta, principalmente, a pacientes inmunocomprometidos. Pocas veces se han reportado casos de afectación periostomal. Clínicamente puede ser confundida con otras patologías, pudiendo tener una evolución fulminante, por lo que un adecuado y pronto diagnóstico son necesarios para una instauración precoz del tratamiento. Caso Clínico: Se presenta el caso de una paciente de 62 años inmunocomprometida, que tras complicaciones quirúrgicas evoluciona con mucormicosis periostomal de la pared abdominal. A pesar de un tratamiento quirúrgico con múltiples resecciones de tejido asociado a antifúngico local y sistémico, la paciente fallece, concordante a la letalidad expresada en la literatura.

Introduction: Mucormycosis is a rare and opportunistic disease that mainly affects immunocompromised patients. Few cases of peristomal involvement have been reported. Clinically it can be confused with other pathologies and may have a fulminant evolution, so an adequate and prompt diagnosis is necessary for an early establishment of treatment. Clinical Case: We present the case of a 62-year-old immunocompromised patient who, after surgical complications, evolves with periostomal mucormycosis of the abdominal wall. Despite surgical treatment with multiple tissue resections, associated with local and systemic antifungal agents, the patient died, consistent with the lethality expressed in the literature.

Instrumentos de avaliação das complicações na pele periestoma: revisão integrativa / Instrumentos de evaluación de complicaciones de la piel periestoma: revisión integradora / Tools for peristomal skin complications assessment: integrative review

RESUMO Objetivo: identificar e analisar os instrumentos utilizados para a avaliação das complicações da pele periestoma por meio de revisão integrativa. Materiais e métodos: realizou-se revisão nas bases e portais de dados: Biblioteca Virtual da Saúde (BVS), PubMed/MEDLINE, CINAHL, Scopus e Web of Science, de janeiro a fevereiro de 2018. Durante a busca nas bases de dados, foram utilizados os descritores: estomia, colostomia, dermatite; e as palavras-chave: instrumentos, complicação da pele periestoma e avaliação da pele periestoma. Foram incluídos estudos que atenderam aos seguintes critérios: estar disponível na íntegra, estar publicado em espanhol, inglês e português, sem limite temporal e versar sobre os instrumentos de avaliação das condições da pele periestoma. Resultados: a análise identificou a existência de nove instrumentos, com diferentes parâmetros para descrever a pele periestoma. De maneira geral, estes descrevem as alterações com base na classificação da complicação, na causa dos danos na pele ou nas características clínicas presentes. Os estudos mostraram, ainda, que a maioria dos instrumentos não possui propriedades de medida testadas. Conclusão: dos nove instrumentos de avaliação identificados, apenas quatro possuem propriedades de medidas testadas. O enfermeiro deve conhecer os instrumentos confiáveis e válidos disponíveis para descrever e classificar a gravidade dos problemas da pele periestoma, o que contribui para a sistematização de um diagnóstico mais acurado e melhora, portanto, a qualidade do cuidado.

RESUMEN Objetivo: identificar y analizar las herramientas utilizadas para evaluar las complicaciones de la piel periestoma a través de revisión integradora de la literatura. Materiales y método: la búsqueda se dio en estas bases y portales de datos: Biblioteca Virtual de la Salud (BVS), PubMed/MEDLINE, CINAHL, Scopus y Web of Science, de enero a febrero de 2018. Durante la búsqueda en las bases de datos, se utilizaron los descriptores: ostomía, colostomía, dermatitis y las palabras clave: instrumentos, complicaciones de la piel periestoma y evaluación de la piel periestoma. Se incluyeron estudios que cumplieron los siguientes criterios: que estén disponibles en su totalidad, que estén publicados en español, inglés y portugués, no se tuvo en cuenta el rango de tiempo y tenía que ser acerca de las herramientas de evaluación de las condiciones de la piel periestoma. Resultados: el análisis identificó la existencia de nueve instrumentos con diferentes parámetros para describir la piel periestoma. En general, los instrumentos describen los cambios basados en la clasificación de la complicación, en la causa del daño a la piel o en las características clínicas presentes. Los estudios evidenciaron, además, que la mayoría de los instrumentos no poseen propiedades de medida probadas. Conclusión: de los nueve instrumentos de evaluación identificados, solo cuatro tienen propiedades de medidas probadas. El enfermero debe conocer los instrumentos existentes confiables y válidos para describir y clasificar la gravedad de los problemas de la piel periestoma, lo que aporta a la sistematización de un diagnóstico más preciso y mejora, por lo tanto, la calidad del cuidado.

ABSTRACT Objective: The aim of this study was to identify and analyze the tools used to evaluate the peristomal skin complications by an integrative review. Materials and methods: A literature review was performed through the following databases: Virtual Health Library (BVS), PUBMED/MEDLINE, CINAHL, Scopus and Web of Science, from January to February 2018. During the search in the databases, the following descriptors were used: stoma, colostomy, and dermatitis. The keywords were: tools, peristomal skin complication and peristomal skin assessment. Studies were added to the following inclusion criteria: articles published in Portuguese, English or Spanish, full paper access, no time limit and they had to be about tools for peristomal skin complications assessment. Results: The analysis identified the existence of nine tools with different parameters to describe peristomal skin complications. In general, they describe the peristomal skin changes based on classification, the peristomal skin complications or in the present clinical characteristics. The majority of the tools have not tested psychometric measures. Conclusion: Four out of the nine instruments identified have psychometric measures tested. The nurse should be aware and must know the existing valid and reliable tools to describe and classify how grave is the skin issue. This in order to give an accurate diagnosis and to improve the care quality.

Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.

A Risk Factor for Wound Infection after Percutaneous Endoscopic Gastrostomy: Decreased Performance Status / 대한소화기내시경학회지

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) has been widely used for long term enteral nutrition. The most common complication is peristomal wound infection. The aim of this study is to investigate the risk factors for peristomal wound infection after PEG. METHODS: We reviewed the records of 55 patients who had undergone PEG placement at Kangnam St. Mary's hospital via the Pull-string technique. We analyzed the underlying disease, the performance status and the nutritional state of the patients to determine the risk factors for wound infection. RESULTS: Peristomal wound infection after PEG occurred in 20 (36.4%) of the 55 patients. Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolated microorganism. On univariate analysis, the underlying CNS disease, non-malignant disease and a decreased performance status (ECOG 3, 4) were correlated with wound infection. On multivariate analysis, a decreased performance status was an independent risk factor for wound infection after PEG (p=0.007, OR=6.011, CI: 1.64~22.09). CONCLUSIONS: A decreased performance status was an independent risk factor for peristomal wound infection after PEG.

Contribution of Nasal Methicillin-resistant Staphylococcus aureus Colonization to Percutaneous Endoscopic Gastrostomy Site Infection and Risk Factors of Wound Infection / 대한소화기학회지

BACKGROUND/AIMS: Peristomal infection is the most common complication of percutaneous endoscopic gastrostomy (PEG) insertion. Methicillin-resistant Staphylococcus aureus (MRSA) is the most commonly implicated organism of peristomal infection. The aims of this study were to determine the contribution of nasal MRSA to wound infection in PEG and the predictors of wound infection. METHODS: A prospective study was conducted on patients undergoing PEG between September 2003 and July 2005. All patients received antibiotics prior to PEG insertion. Nasal swabs were taken from a consecutive series of patients prior to PEG insertion. Wound status of the peristomal site were prospectively evaluated at day 1, 3, and 7 following the insertion of PEG. RESULTS: Thirty-one patients underwent PEG insertion (mean age, 66+/-16 years). Ten patients (32.3%) had MRSA-positive nasal swabs. Peristomal infection did not have any relationship with nasal MRSA colonization (p>0.05). Peristomal infection occurred in 4 (12.9%) cases. The rate of peristomal infections was significantly higher in patients with diabetes mellitus (p<0.05). CONCLUSIONS: Nasal MRSA colonization is not associated with the risk of peristomal infections in patients receiving antibiotics prior to PEG insertion. Diabetes mellitus might be the risk factor for peristomal infection after PEG insertion.