Via Research Recognition Day 2024 VCOM-Carolinas

Clinical Case-Based Reports

Challenges in Ostomy Care and Management: A Case Report of a 23-Year-Old Male with Ulcerative Colitis, Subtotal Colectomy, and Formation of Ileostomy

Maheen Farooq OMS-II, Mariam Aamir OMS-II, Ronald Januchowski DO Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina , Case Presentation

Introduction Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by the inflammation of the colon and rectum. UC often becomes a debilitating disorder with symptoms such as abdominal pain, bloody diarrhea, and weight loss 1 . Despite advancements in treatments, some cases prove refractory to conservative management and may necessitate surgical intervention such as subtotal colectomy with ileostomy creation. Subtotal colectomy with ileostomy creation is usually done in cases where there is severe inflammation, colonic perforation, or dysplasia. This surgical approach results in the removal of the colon and rectum in addition to the creation of an opening in the abdominal wall through which the small intestine is brought to the surface as seen in Figure 1. As a result, fecal matter is diverted into an external pouch, allowing for the restoration of the gastrointestinal function, and alleviating the associated symptoms.

Figure 3. Management of Ostomies A. 1- vs. 2-piece pouch 2 B. Stoma measuring guide 2 C. Skin Barrier Ring 2

HISTORY OF PRESENT ILLNESS: • A 23-year-old male, previously diagnosed with ulcerative colitis in January 2022, underwent total proctocolectomy and ileostomy creation due to refractory disease. • Symptoms included fatigue, decreased physical activity tolerance, increased daily loose bowel movements, abdominal pain, tenesmus, and weight loss • Referral to gastroenterology after abnormal fecal calprotectin, ESR, CRP, platelets, and anemia values • Colonoscopy revealed acute severe pancolitis; treated with oral prednisone and mesalamine, then high-dose infliximab • Lack of response led to outpatient IV solumedrol for 5-6 days; repeat colonoscopy showed partial improvement • Hospital admission due to worsening colitis, 50-pound weight loss, and persistent symptoms • Steroid taper and pain medications resulted in reduced bowel movements but no improvement in abdominal pain • Decision for subtotal colectomy in March 2022 due to the impact on daily living • The cecum to the sigmoid colon was removed and the rectum was stapled shut.

Conclusions

The experiences of this young male patient with ulcerative colitis and ileostomy creation highlights the significance of a comprehensive approach to ostomy care.Adequate patient education, support from specialized healthcare providers, and ongoing follow-up are crucial components of successful ostomy care. This case report emphasizes the need for primary care providers to address the specific challenges faced by individuals with ostomies, promoting improved quality of life through patient education, support, and ongoing management. KEY POINTS • Primary care providers should reiterate the importance of regular medical check-ups to monitor and detect potential issues early. • Routine follow up appointments can allow the provider to evaluate stoma function, address lifestyle changes, manage complications, and adjust treatment options for the patient. • Patient education and support from subject matter experts (such as ostomy care nurses, wound care centers) are critical for the overall care of the patient. • This case report provides family practice physicians with the knowledge to navigate the intricacies of intestinal ostomies, fostering enhanced patient care and ensuring a holistic approach to the management of individuals with these surgical interventions. Ostomy care incorporates more than the physical management of the stoma, extending into lifestyle adjustments and a holistic consideration of patient well being. The collaboration of patient and provider efforts is crucial in developing and maintaining a balanced approach to ostomy care.

Figure 2. Stomal Complications A. Healthy Stoma 2

B. Stomal Dermatitis 3 C. Stomal Prolapse

Figure 1. Ileostomy Anatomy 2 An ileostomy is a surgically created opening in the ileum of the small intestine .

Although this procedure can be curative, it requires a profound adjustment in the patient’s lifestyle. Patients tend to face challenges related to ostomy care, the psychological impact of living with a stoma, and the possible postoperative complications. Complications may include stoma prolapse, bowel obstruction, leakages, infection, and nutritional deficiencies. Due to the various challenges, it is important for primary care physicians (PCPs) to understand the background of UC and the complexities involved in managing this chronic condition to serve as a beneficial point of contact. Specifically, PCP’s can coordinate directly with patients and other medical specialists to assist in providing comprehensive, patient centered ostomy care. Therefore, the aim of this case report is to shed light on the importance of comprehensive ostomy care, addressing physical aspects, post operative complications, and management of intestinal ostomies.

MANAGEMENT: • Postoperatively, the patient encountered challenges such as skin irritation, leakage, stoma obstructions, and stoma prolapse. • The patient’s primary care provider advised him on basic management of the ileostomy and surrounding skin. • The PCP has routinely stayed in contact with ostomy supply companies to ensure that the patient has had adequate ostomy supplies, including pouch systems, stoma appliances, and barrier rings. • The patient was referred him to the wound and ostomy care center for ostomy related application appliance issues and complications including peristomal dermatitis. • The patient was advised to seek further evaluation for complications such as stoma prolapse and bowel obstructions, which in some cases, necessitated medical intervention.

References

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2024 Research Recognition Day