Paris, Here We Come: Helping an Ostomate’s Wish

Case: Patient had a sigmoid resection from outside facility complicated by multiple bowel obstructions and surgeries resulting in short gut syndrome. Patient suffered with constant peristomal skin irritation due to a poorly functioning stenosed jejunostomy. Quality of life is poor due to hourly pouch changes even with the use of various pouches. Patient had to stay at home due to fear of leaking, feelings of depression, and fatigue.

Patient decided to undergo another surgery to revise her jejunostomy. An extensive lysis of adhesions, attempted restoration of intestinal continuity, and revision of jejunostomy was done. Initial meeting with WOC RN the day after surgery revealed a recessed stoma and a surgical incision at risk of dehiscence. Six days after surgery, patient’s surgical incision dehisced and her jejunostomy retracted down below the abdominal plane. Multiple attempts to pouch the jejunostomy with surgical packing were done but failed to produce desired result. Negative pressure wound therapy (NPWT) was entertained, but there was a problem with isolating the jejunostomy from the rest of the surgical incision.

Solution: Use of a collapsible enteroatmospheric fistula device to isolate the jejunostomy and apply NPWT together with a pouching system. Once NPWT with collapsible enteroatmospheric fistula device was no longer appropriate, WOC RN team utilized a fistula pouch attached to low wall suction. Upon discharge to home, patient continued with fistula pouching system (with no suction), which provided her 1–2 days’ wear time. Once the jejunostomy matured, slight peristomal irritation was still noted. WOC RN team decided to do custom molding of the patient’s stoma to create a customized pouch. This helped clear the peristomal irritation and provide the patient 4–5 days’ wear time. Both the patient and her husband confirmed that this greatly improved their quality of life, even allowing them to travel together on a European vacation!