Can You Help?

  One of our new home health care patients has a 2- to 3-year-old ostomy. The patient is in her late 70s and has been independent with her ostomy care. She was referred to home health care because she developed a bright red blood blister on the stoma located at 1:00. It bleeds when she cleans the stoma or touches it. Our RN case manager is using zinc powder on the area. The peristomal skin is fine. Can anyone provide direction as to how to treat this?

Comments

Biopsy tissue to r/o malignant process

This may be a polyp, if it is, should be removed.
Refer to a gastroenterologist

The medline product Marathon could be the answer. It serves as a second skin without the messiness of a cream or the bulk of a dressing.

You might consider treating with silver nitrate sticks if you have not already tried it. It may take several applications at least 3-4 days apart to resolve. It is an old remedy also used for hypergranulation tissue.

I would use a silver nitrate stick to cauterize it.
May need to assess new medications--such as chemo or steroids. Underlying disease? Does she have Crohn's disease?

Without seeing it, would be hard to say, first impressions would be either a varices or a site of irritation from rubbing. Make sure wafer is cute large enough and if area doesn't improve, send her to a surgeon for eval.

I would want to know why she has a colostomy. Was it for cancer or UC? If so, I would ask for MD referral to check for cancerous lesion?

Try a piece of Iodoflex product

Try using the hydrofera blue ostomy ring, cover it with the ostomy skin barrier.

I would send this patient to her PCP to ascertain why the blister developed. My first thought was a cancerous lesion has developed. The most permanent fix would be cautery. Blood blisters on the colon or in this case the stoma are not normal. If the stoma is being chronically mechanically irritated, again the cause of irritation would need to be addressed and fixed.

Etanita's picture

Don't touch it! There is no need to clean the stoma itself .. it's self cleaning! clean the skin around the stoma only. She needs to see her GI doctor, it may be a polyp or irritation from cleaning it and may need to be cauterized or removed. No need to apply any powders to the stoma.

Use a silver nitrate stick. It likely is just a large capillary.

I believe you/she should get this biopsied. It could be a cancer, esp relating that it is so friable. maybe it needs revision if it is not a malignancy.

It may be a malignancy. I'd arrange for biopsy. It may be another GI disorder. Maybe she needs a revision.

I would wonder if she is having some recurrent trauma to this area?

In assessing this client I would complete a thorough history-

-is there any remote possibility that the client contributed to the problem-long hard fingernails that may have caused damage to the bowel lining?

_does the client have a history of inflamatory bowel disease/ transmural disease, ulcerative colitis? If yes suggest a gastroenterologist be consulted.

Hope this is of assistance

Try using a ostomy bag that is much larger than the stoma, leaving the excoriated area open to the inside. On the excoriated area use a barrier paste called Endit, manufactured in Shallotte, NC. This produce is excellent to use on blisters and excoriated skin. It not only heals but protect the skin from moisture which is what this type of wound needs. Hope this helps.

The bag flange should only ever be cut 2-3 mm bigger than the stoma. If it is cut too large the patient will suffer irritation from faecal to skin contact causing infection or granulomas (over growth of tissue) which can incidently look like polyps at the edge of the stoma.

A better description of the problem is needed. Is it a blood blister really or a more indurated lesion? Is it more on the peristomal skin and what does the peristomal skin look like?
Your best bet is to have the stoma evaluated by a WOCN who can assess the condition and better guide you and the patient in proper interventon.

Tx with zn oxide is not necessary. Why the blood "blister" (not blister perse). Mucosa tends to heal readily if no other underlying pathology. Is pt using a two piece and incidently caught mucosa in attempt to seal? Trauma from clothing, seat-belt? With gentle cleansing a stoma
can transfer blood to cloth. It is not necessary to clean stoma, can wipe off excess stool as needed with toilet paper or personal flushable hygience wipe. This most likely is normal unless
a coagulopathy (or more pronounce with Coumadin therapy)

I would observe at next pouch change or at visits through transparent pouch. If increases need to further evaluate, if resolving and etiology not clear then would not necessarily spend more
time sleuthing.

Consider excisional biopsy.

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