Optimizing Peri-Stomal Complications with New Technology

A 57-year-old female with Crohn's Disease is s/p recent colostomy revision complicated by poorly controlled severe pain secondary to pyoderma gangrenosum (PG) and irritant contact dermatitis from leaking stool. A recent 21-pound weight loss resulted in an ill fitting ostomy appliance and along with loose stools contributed to leakage under the flange.  Despite four appliance changes for improved fit, trying multiple ostomy and wound products, and steroids in PG wounds, she required recent admission for pain management and dehydration. She was undergoing daily appliance changes due to severe burning pain around the stoma. With her gastroenterologist's approval, she stopped using alginate and trialed a novel transforming powder dressing into both the PG wounds as well as the peristomal skin irritation.  Under the direction of a certified ostomy nurse, her stool thickening regime was changed, and she was educated on skin care.  Within one week, her pain had gone from severe to minimal in her PG wounds, and the quality of those wounds was markedly improved. The peristomal skin complications (except for the PG) had resolved. She was able to keep the appliance on comfortably for 4 days continuously without pain or leakage, and no longer needed oral pain medication.  She was grateful with the outcomes, and especially with the pain reduction in her PG wounds since starting to use the transforming powder dressing. Patients with ostomy complications are challenging, but with a targeted approach these complications can be optimally managed, and many times resolved. This patient was able to apply an ostomy appliance directly over damaged skin that was protected by the powder dressing, maintaining a good seal to avoid leakage.  Involving an ostomy nurse specialist and utilizing new wound care technologies (such as a transforming powder dressing) to protect the skin is key to successful interventions.