Pediatric emergency medicine trisk 4682 4682

maintenance of a good seal between the ostomy pouch and the stoma. Contact
dermatitis may occur either from leakage around the stoma or from allergy to
stomal materials such as tape or pouches. Removing the offending material often
successfully treats this condition. Infection with C. albicans is fairly common
because of the persistent moisture and the frequent use of antibiotics. Treatment
with antifungal agents such as clotrimazole, especially powders, is effective. The
powder can be mixed with a small amount of water and painted onto the skin to
enhance adherence of the pouch. Ointments and creams should be avoided in
fungal infections. Skin bleeding resulting from prolonged irritation of the
peristomal area is usually minor. The cellulitis that can occur if the skin
excoriation worsens is treated with systemic antibiotics.
Stomal Complications. Stomal stenosis is not always detectable to the parent or
practitioner and may present with reduced or absent output, diarrhea, or cramping
abdominal pain. When severe stenosis occurs, it usually presents as obstruction.
To assess the degree of stenosis, the physician should gently examine the stoma
digitally unless the stoma is too small. In this case, a catheter should be carefully
passed. If abdominal obstruction is suspected, radiographs of the abdomen and
urgent surgical consultation are indicated.
Prolapse of the stoma occurs in more than 20% of patients with stomas and is
usually not an emergency. However, skin excoriation, bleeding, and incarceration
of the bowel may occur. The situation becomes more urgent if the prolapse is
associated with pain, decreased output, or a dusky stoma color that represents
circulatory compromise; this requires immediate surgical management. This
includes easing the prolapsed contents back into the stoma using both hands. This
procedure may need to be done repetitively until such time that definitive surgical
repair is undertaken.
Retraction of the stoma because of excessive tension may cause the stoma to
recede beneath the skin. This condition occurs more often than prolapse in
patients with ileostomies. Stomal retraction makes it difficult for a pouch to
adhere to the skin. Retraction can also result in cellulitis or even peritonitis,
depending on the location of the detachment and the flow of the effluent.

Management usually includes antibiotics and if the retraction is extensive,
surgical correction is indicated.
A hernia of the peristomal contents occurs when there is a protrusion of the
colon or ileum into the subcutaneous layers of skin surrounding the stoma. This
complication may impede adherence of the ostomy pouch but does not usually