Creating the Perfect Fit

Introduction: Open cecostomy is a surgical procedure where an opening is created in the cecum to relieve cecal distention. Cecostomy is rarely performed in adults due to potential negative outcomes.

The procedure is primarily performed in children using a percutaneous cecostomy tube in the cecum rather than open cecostomy. A 70-year-old male presented with abdominal pain and distention, found to have colonic pseudo obstruction and Ogilvie's syndrome. Though initially treated non-operatively, the patient’s condition required surgical intervention. An open cecostomy was performed on the patient, rather than placing a percutaneous cecostomy tube due to the patient’s acute clinical condition. Stoma care and pouching for an open cecostomy is a challenge due to the unique stoma. While this procedure can be lifesaving, it is also major life changing, with a difficult to pouch stoma that needs to be specially addressed.

Methods: Using the open cecostomy surgical procedure outlined in Chasin’s Strategy in Operative Surgery as reference, an open cecostomy was performed. Traditional ostomy appliances could not be used due to the unique stoma shape. Instead, the Stoma Molding Kit was used to create a mold of the difficult to pouch stoma. A tracing of the stoma was made for post molding reference. To make the mold, water and powdered alginate were mixed thoroughly. The alginate was poured over the stoma and surrounding area and allowed to set. The set mold was removed, kept moist, and sent to Nu-Hope to produce samples.

Results: A unique mold of the patient’s ostomy was produced by the lab and able to be secured to the patient without issues.

Discussion: Unique surgeries and resulting stomas require extensive emotional support and creative solutions. With proper support and custom pouching, the patient was successfully discharged with a better quality of life.