Stoma and Peristomal Complications and Assessment Details

This article discusses stoma and peristomal complications, their etiology, pathophysiology, assessment details, and recommendations to solve the problem. It also includes pictures related to the stoma and peristomal infection.

Running head: STOMA AND PERISTOMAL COMPLICATIONS
STOMA AND PERISTOMAL COMPLICATIONS AND ASSESSMENT DETAILS
Name of the Student
Name of the University
Author note

1STOMA AND PERISTOMAL COMPLICATIONS
Creation of intestinal or urological stomas is an integral part of the surgical interventions for several complications such as
gastro-intestinal tract disease (Salvadalena, 2013). Numerous people undergo surgical interventions every year resulting in intestinal
or urological stoma. The modern healthcare system uses several means such as ostomy equipments or pouches, providing the patient
access to wound ostomy continence (WOC) expert nurses and advanced wound care system (Baykara et al., 2014). However, as these
means decreased the hospital stay of patients, they are unable to manage their wounds using ostomy basics, leading to high morbidity
and affecting the patient, physically, psychologically and economic prospect (Kwiatt & Kawata, 2013). These peristomal skin
complications are divided into five categories such as mechanical, infection related, noxious chemicals and irritants, skin allergies and
disease related to the skin (Jonkers et al., 2012). This assignment will be identifying five pictures related to the stoma and peristomal
infection and will discuss their etiology, pathophysiology, stoma and peristomal assessment, the way these conditions affect the
patient and the pouching system and finally recommendations to solve the problem. The assessment will be presented in a tabular
format.
Picture 1
Picture 1: Peristomal contact dermatitis
Etiology  The primary reason for this condition is exposure to
urinary or fecal drainage.
 This condition is also known as contact irritant dermatitis
and exposure to chemicals may lead to such condition
around the stoma (Haugen & Ratliff, 2013).
 It can also occur due to enzymatic drainage. Furthermore,
exposure of the stoma to adhesives, solvents and soaps as
well as leakage from the stoma pouch mat also lead to
such infection (Meisner et al., 2012).
Pathophysiology  Presence of erythema with swollen skin around the stoma,
Presence of pruritus, vesicles and papules, redness, dark
and discolored skin around the stoma
 Furthermore, the stoma was observed as oozing and a well
defined circular layer of erythema, edema and burned out
skin was observed (Grey et al., 2013).
Stomal assessment  Moist and oval shaped, red (healthy) stoma was observed.
Protrusion was around 1-2 cm from the skin surface and
located near the lower right quadrant of skin fold surface
of abdomen.
 Yellowish circular patch was observed and from the end
stoma tip a yellowish exudates was oozing which had
paste like consistency.
 It had shiny, textured and bloody appearance having oval
shaped bud, around which red swollen allergic condition
was observed

2STOMA AND PERISTOMAL COMPLICATIONS
Peristomal assessment  The peristomal area is spread around the wound in 2-3cm
radius.
 No hair was observed on the skin, however the skin
folding were present.
 The adjacent area of the peristomal skin appears red and
yellowish, yellow streaking on red erythema skin. Intact
skin integrity, moist texture, and normal turgor was
observed.
 Further, away from stoma the skin has a red rash in a
circular pattern all the way around the stoma where the
wafer would sit.
Patients condition  The patient develops irritation, itching, burning sensation,
discomfort and due to the exudates from the stoma bud,
infection spread to other body parts as well.
 This will increase the inflammation and erythema to
spread. Papules in the stomal area may lead to spread the
infection by releasing effluents (Grey et al., 2013).
 Further, the pain may also increase, as once the sensitivity
presents, it is usually permanent.
 This is because; the ostomy care products used on the skin
could potentially cause a reaction that leads to allergic
condition as well as pain sensation in the stoma area
(Martins et al., 2012).
 This might affect the patient psychologically and usage of
these costly product can affect the patient economically as
well.
Pouching system condition  The pouching system has to suffer as cleansing becomes a
challenge due to chemical and urine related infection.
 Hence, the proper pouch that can fit the area properly
should be instead of leaky pouch, which lead to spread the
exudates from one area to another leading to inflammation
and allergic condition (Grey et al., 2013).
How to deal with the problem  Correct size opening pouch system can be used,
using an ostomy belt or a convex skin barrier
instead of a flat one, using crusting method so
that dryness can be maintained
 convex barrier or flat barrier ring for stoma
management. Using warm water for cleansing
and application of stoma power for weeping can

3STOMA AND PERISTOMAL COMPLICATIONS
help in the treatment (Haugen & Ratliff, 2013).
 Usage of soaps, solvents and other chemical
products should be prohibited.
 As well as, usage of medicinal solvents should
also be prohibited as it can lead spreading if the
infection in other regions as well. This is
because swollen bruise can lead to loss of skin
(Meisner et al., 2012).
Picture 2
Picture 2: Candidiasis and folliculitis
Etiology  The primary reason is fungal infection due to overgrowth
of Candida albicans, which is the normal flora of the
mouth, gut and vagina.
 red rash, pustules and satellite lesions, may have a
collar/edge with a scaled appearance (Rippon et al., 2017)
 Traumatic hair removal due to pouch removal can be the
reason for the elevated skin surface and related infection
 Thus, inflammation leads to erythema and edema around
the stoma infection.
 Shaving the peristomal skin around the stoma prior to
application of pouch can also lead to the formation of
follicular and Candidiasis related stoma infection. Further,
occlusion of the hair follicles and in the process ripped
skin barriers can lead to stoma related infection (Huq,
Rahman & Hossain, 2014).
Pathophysiology  Leaking pouch system with red and swollen radius around
the infection
 Papules, pustules and pruritus is observed
 Satellite lesion with raised pustules was
observed due to folliculitis.
 collar/edge with a scaled appearance was also observed in
the lesion
 overgrown bud with red appearance observed (Huq,
Rahman & Hossain, 2014)
Stomal assessment  Dry and round reddish stoma was observed, having
protrusion more than 4 cm from the skin level.
 The infection is located in the lower right quadrant of the
abdomen, 4 to 5 inches elevated swollen and reddish

4STOMA AND PERISTOMAL COMPLICATIONS
allergic area was present around the stoma.
 Loop stoma was observed having dark red color, the
appearance of the bud was shiny, dry and bloody having a
circular appearance
Peristomal assessment  The peristomal skin around the stoma was reddish and the
traumatic hair follicle removal due to pouch removal lead
to red and swollen skin periphery near the stoma.
 Scars and crusty skin integrity, with firm turgor was
assessed
 Round or rotund abdomen. Further, away from stoma the
skin has a red rash in a circular pattern all the way around
the stoma where the wafer would sit.
Patients condition The patient is at higher risk of developing abcess, increased itching,
discomfort leads to spread the infection to other adjacent regions.
Financial and psychological impact might also impact the patient
condition
Physically as well, the position of scar was such that the patient would
not be able to move freely.
Pouching system condition  The pouching system leads to leaking; affecting the stoma,
further occlusion of hair follicle can also be seen.
 Therefore, lift of, and secondary accessory might be seen
in this scenario.
 The pouch becomes loose, leading to spread the infection
from the stoma to another portions of the body (Beitz &
Colwell, 2016).
How to deal with the problem  Removal of all the hair before application of pouch should
be done, adhesive remover should be used, antimicrobial
soap and power should be used, proper elimination of
moisture should be done, further a pouch cover should be
used to protect it from moisture (Huq, Rahman & Hossain,
2014)
 If the patient has history of fungal infection, then
prophylactic treatment should be used, the caretaker and
patient should be taught the skills to protect stoma
infection in condition of Candidiasis and folliculitis
(Rippon et al., 2017).
 The pouch should be changed in short term duration and
in that process, usage3 of antifungal treatment powder
should be applied in the inflammated area. These

5STOMA AND PERISTOMAL COMPLICATIONS
antifungal powders (Nystatin and Mycostatin) should be
used to dust the area, massage on the reddish skin around
the stoma, let sit for several minutes. Further, excess
powder after massage of the skin should be removed prior
to application of pouch (Lyon, 2016).
Picture 9
Picture 9 : Allergic contact dermatitis
Etiology  The primary cause for allergic contact dermatitis is usage
of any product, which is allergic to the patient, as this
condition is not related to leakage from pouch.
 Further, not proper cleansing of the peristomal skin may
also lead to allergic conditions (Kaur et al., 2012).
 Usage of film barriers or additional tape may also involve
in the cause of such infectious condition.
 Furthermore, an appliance having a bad fitting, letting
moisture or vapor infect the area may also lead to such
allergic condition.
 Whereas, frequently changing apparatus, ripping off the
appliances, irregular borders and abrasive cleansing of the
area also leads to allergic condition in case of stoma
related infections (Watson et al., 2013).
Pathophysiology  This stoma infection is present with erythema or redness
due to increased blood flow around the peristomal skin.
The primary stoma site appears as “bulls eye” target,
swelling around that target is observed and the “bulls eye
target” appears darker and oozing.
 Furthermore, the patient feels itching, burning or stinging
around the infection site (González-Rodríguez et al.,
2013).
 Partial or full thick allergic reaction may be seen near the
stomal area. Regular or irregular swollen border around
the stoma bud is the characteristic of allergic contact
dermatitis.
 This infection is itchy and painful and might lead to spread
due to exudates release (Kaur et al., 2012)

6STOMA AND PERISTOMAL COMPLICATIONS
Stomal assessment  Round, red, moist mucosa was observed
 flush or low profile stoma
 end stoma, intact muco-cutaneous junction
 Lumen was observed in the4 center of stoma
 Likely an ileostomy as it is on the right lower quadrant
Peristomal assessment  Redness in the skin is observed, due to allergy, patching,
or usage of tapes and bandage.
 However, the skin color is healthy.
 The skin integrity is intact.
 No hair was observed on the body.
 The skin texture is crusty, normal skin turgor (palpation
test)
 Away from stoma, the skin has a red rash in a circular
pattern all the way around the stoma where the wafer
would sit.
 Lower right hand aspect of the skin shows mechanical
stripping and denuded skin.
Patients condition  This allergic contact dermatitis increases the pain around
the stoma site, itching and irritations leads to discomfort.
 It can affect the activities of daily life of the patient
 Further discomfort can affect the mental state and to treat
that financial strength would be required. Hence, all the
aspect might suffer due to this wound.
Pouching system condition  The pouching system is also affected as papules and
vesicles create complication in the ostomy management
(Watson et al., 2013).
 The place of stoma was such that it may affect the
integrity oif pouching as lift up might occur, and pouch
management was crucial.
 Specific secondary accessories might also be required to
keep the pouch on the place.
How to deal with the problem  The allergen product should be removed, as removal of
offending product will remove the allergic condition.

7STOMA AND PERISTOMAL COMPLICATIONS
 The fragranced stoma bag deodorizer should be checked,
the stoma appliances such as soaps, wipes adhesive
removers should be checked for allergic dermatitis.
 The caretaker of the patient should use non-oily steroid
cream and powder (Gardiner, 2013).
 To protect the stoma, an interface such as a Coloplast
barrier sheet can be used if any proper pouching system is
not available that can properly fit in the stomal region
(González-Rodríguez et al., 2013).
Picture 5
Picture 5: healthy stoma with contact dermatitis around the lesion
Etiology  It is a healthy stoma, which is in the primary stage of
development
 The stoma developed contact dermatitis because of the
presence of infected substances around the patient
 The ulcer may spread due to open surface and microbial
infection as well as due to the release of exudates from the
stoma (Wu & Shen, 2013).
Pathophysiology  Shallow and deep ulcer having cavity witnessed, having a
reddish and ragged edge surrounded by swollen and
reddish skin is observed
 Further, the allergic condition may be due to irritants or
pouch related allergens used in the process.
 The ragged edges of the swollen skin around the stoma
are whitish or yellowish in color and the skin is hard and
broken textured which may lead to blackish blemish
Stomal assessment  Moist and round cavity was observed, which is bud
shaped and shiny red.
 The cavity was 2-3cm deep, located in the smoother
section of the belly. Possible the left lower section of the
body.
 The periphery of the cavity was swollen and reddish
allergic condition was observed.
 Red mucus was observed, which determines healthy
stoma. Further, shiny, smooth and textured cavity was
observed
 Lumen was present in the center of the stoma and it was
in developing stage with intact muco-cutaneous junction.

8STOMA AND PERISTOMAL COMPLICATIONS
Peristomal assessment  The surrounding of stoma was light reddish and further
only edema was observed,
 The peripheral skin was normal in color and therefore
denoted healthy peri-stoma however had broken structure
with whitish skin rashes.
 Redness was observed due to the allergy spread by the
released exudates from the stomal cavity, which made the
skin around the cavity inflammated and leading to
symptoms of erythema and edema around the stoma
where the wafer would sit.
Patients condition  Itching and pain can be the discomfort and further healing
of the lesion leads to formation of cribriform scars, which
appears as small hole.
 Further, the patient suffers from high risk of microbial
infection that can occur from the normal microbial flora of
skin in that area
 However, less financial and much more psychological
trauma can be faced by the patient
Pouching system condition  The pouch may be affected due to swollen cavity in the
stoma infection site
 However due to the smoth surface, it will not dislocate of
lift up.
 With the increasing size of stoma, the pouch wear time
and need of addition of secondary accessories can be
increased,
 Therefore, special cavity convex pouches should be used
for the protection of the stoma
How to deal with the problem  Usage of topical steroid agents may be beneficial as using
this application of systematic steroidal agent leads to
healing of the wound (Wu & Shen, 2013)
 Further Pain management and Time management is also
beneficial in the faster healing of the wounds.
 Cleansing and hygiene should be maintained properly as
this stomal condition may lead to severe condition.
 Hence, the care taker and the patient as well should take
care of cleansing using medicinal solvents and warm
water should be done so that further infection can be
prevented (Fahmy et al., 2012).

9STOMA AND PERISTOMAL COMPLICATIONS
Picture 11
Picture 11: Pyoderma Gangrenosum with allergic reaction
Etiology  The primary etiology is the presence of inflammatory
bowel disease. Further, due to the usage of allergic
substances in the pouch management, allergic condition
arises.
 It is often associated with autoimmune diseases such as
ulcerative colitis, Crohn's disease and rheumatoid arthritis
(Ahmad et al., 2017).
 There is also a possibility that due to not frequent changes
of the pouch of this stomal region, infection spreads
through the exudates.
 People with blood disorders (hematologic malignancies)
are at increased risk of pyoderma gangrenosum
Pathophysiology  Irregular budded stoma, with reddish brown color, and
cavities around the stoma was observed. This occurs
mainly because of the variety of immune mediators such as
IL-8, IL-1β, IL-6, interferon (IFN)-γ, G-CSF, TNF, which
is elevated in the patients affected with Pyoderma
Gangrenosum.
 Further, the circular periphery had reddish swollen skin
represented erythema and edema (Randall et al., 2012).
Stomal assessment  Swollen, reddish, irregular stoma was observed, having
irregular swollen network of skin around and over it
forming the border. The stoma was protruded by 2-3cm
from the skin level of that area.
 Reddish moist mucosa was observed in the center.
 The stoma was present on a smooth surface. Healthy
reddish stoma, with shiny and textured layer was observed.
Further, around the stoma small holes having yellow
patches were observed.
 Possibly, it is the right upper quadrant of the body.
Peristomal assessment  No hair was observed on the abdomen, intact skin was
present near to stoma
 However, the closer skin had several perforations in it.
 Further, away from stoma the skin has a red rash and it was
spread unevenly.

10STOMA AND PERISTOMAL COMPLICATIONS
 It was a plane surface for the wafer to sit on.
 Lower right hand aspect of the skin shows mechanical
stripping and denuded skin
Patients condition The physical impacts may include, restlessness, pain, itching discomfort
furthermore, infection may spread to other regions due to the smudged
exudates.
Psychologically having around on upper left quadrant can impact the
patient as it would stay always in their mind and they will not be able to
move freely. However, financially it is not that costly to avail treatment
of this system.
Pouching system condition  The pouch will be unable to stay at proper place due to the
position of the wound. Further, leakage of effluent from
stoma may also displace the pouch. This made moisture
and microbial load to infect the stoma.
 Further, due to irregular shape of the stoma and protruded
and barrel shaped non-cellular lumen of the stoma, it is
difficult to properly cover this stoma with pouch, hence, the
brand will be changed and special bandage or custom
pouches made for the specific stoma will be used to protect
this lesion (Randall et al., 2012).
 This will affect the general bandage time, as it will
frequently lift off the place. Hence, to make it stay on the
place secondary accessories will be used.
How to deal with the problem  Cleansing of the opening with warm water and solvents to
prevent the exudates from spreading, stomal relocation and
surgical reconstruction might also be used as a disease
prevention intervention (Kwiatt & Kawata, 2013).
 Od puch changes will be used for wound management
 Properly fitting appliances will also be used as secondary
accessories to protect the infection from moisture (Grey et
al., 2013).
 Using convex shaped pouch can be helpful in this
condition, as the convex shaped pouch has and outward
curve, that puts enough pressure around the stomal area and
this pressure will help the stoma to protrude into the pouch.
 Topical steroidal agent and systemic steroidal therapy will
be used for this purpose.
There are several implications of stoma and peristomal issues both for the patient and the caregiver assessing their
development. These complications may range from small ulcers and edema/erythema to deep cavity and thick skin ulcers. Further

11STOMA AND PERISTOMAL COMPLICATIONS
there are also examples of contact dermatitis due to allergy or irritant, fistula relates stoma complication, peristomal skin
complications and the treatment. Management and prevention is different from one another. Therefore, the role of assesso9r is very
crucial, as they have to assess accurately the type of stomal and peristomal infection and chose appropriate intervention for the
treatment. Prevention and treatment both are important as prevention helps to avoid the complication to occur in present and in future
and if it is combined with proper treatment, it will help to fasten the healing process. However, adding the patient and their family in
the prevention process increases the degree of it as educating the patient will help him or her to stay aware of the conditions that can
lead to infection. Hence, such assessments, treatments and education should be provided to the patient through properly trained
ostomy nurses, so that the patient can be influenced to maintain stomal pouches, and use the products that are prescribed by the
physician for the proper healing of the stoma and peristomal infection.

12STOMA AND PERISTOMAL COMPLICATIONS
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