Male, 68 years old

Patient history

He underwent a Panproctocolectomy and APER (Abdo-Perineal Excision of Rectum) with end ileostomy in November 2018.

He made a quick recovery and had no problems with his wound. He was discharged on a flat bag. He was followed up routinely in clinic and it became apparent quite early in his recovery that he would need a convex bag as his stoma was flush to the skin and in a dip to the outer aspect.

Complications or problems being experienced

At four weeks post-op it was discovered that the patient had developed numerous large granulomas at the suture sites giving the appearance of a ‘cobble stone’ ring around his stoma. This was treated successfully on a weekly basis with Silver Nitrate. After four weeks the problem had resolved.

The patient changed onto a convex bag. He started chemotherapy, which he tolerated well. However, on session 4 of 8 chemo sessions, the patient called into the hospital complaining of sore skin. He attended the clinic and we observed red dry skin under the flange with a halo of very dry deep red skin around the stoma and also the outer ring of the flange.

Treatment

The patient was given a barrier cream to try followed by barrier film. This treatment did not help and he was prescribed Hydrocortisone 1% cream and suggested he return to his flat bag with a convex washer. Over the following week the skin did improve slightly, but he was now experiencing leaks and only achieving a wear time of 6 hours. Swabs were taken and no infection found. The patient proceeded to trial numerous convex bags and was reacting to all hydrocholloid flanges used.

He became housebound as he was experiencing severe leaks. We found, at the time, the best outcome was to wash the skin with emollient, leave the skin exposed for as long as possible, then to apply a skin wafer, convex bag with a belt and the added security of a Support ring.

At this time, his skin was still deteriorating and we requested an urgent dermatology referral and the opinion of the Oncologist.

I saw the patient in clinic again, which was followed by a visit from our Oakmed representative. I explained the situation with the patient and my concerns that there was nothing we were trying which was working. She explained to me that Oakmed were in the process of trialling an alginate soft convex bag. It was agreed that Oakmed would supply trial packs for the patient if he was in agreement. The patient was ‘more than happy to give anything a try’ at that stage.

The area of red, wet, excoriated skin was worse and the oncologist decided to stop the chemotherapy after 7 sessions.

The samples arrived after a week and the patient was encouraged not to use any of the barrier creams, or wipes with the product, to get a true outcome. After one week the skin was vastly improved and by week 2 it had improved so much that he was able to get 24 hour wear from the bag.

He found that the flange, when warmed onto the skin, adhered extremely well and that he had no leaks whatsoever. The patient’s skin continued to improve. The trial period was for 4 weeks. At the end of the initial trial period the patient was very disappointed as he had had such wonderful results, that he had to revert to his original bag. We saw a marked deterioration in his skin again.

We made contact with our Oakmed representative and explained the situation. She was able to source more samples and the patient’s skin continued to remain in very good condition. The patient is now able to wear the same bag for 48 hours, with no leaks. He is also now able to ‘not double belt’. He is confident that his bag will not leak and he is back to caring for his family.

Conclusion

The patient found that the Oakmed Drainable Standard Alginate Convex bag SCA45-4120KV resolved his extremely severe skin problem and he has stated he will never change from this bag again.