My other colleagues are also welcome to comment, but it’s been my experience that lacerations on the stoma itself are due to the patient’s poor technique in self-management of their ostomy coupled with an appliance that is in appropriate for the patient. The latter often causes the former. My advices is to identify a certified ostomy nurse or ostomy clinic to which you can refer the patient. It is also helpful to identify the brand of the ostomy appliance(e.g. Convatec, Hollister, Coloplast, etc.) and call their help line…an ostomy nurse is on the other end to help you through this. I also give the patient the number. These companies can help provide great advice and sometimes products.
If the laceration is not bleeding, there is no need to treat it…the mucosa heals pretty quickly. If it deep and bleeding, control the bleeding and have your local general surgeon take a look. Teach your patient how to apply direct pressure to the area if bleeding occurs..and of course,when and where to seek care.

Ok, thanks, that’s what we did. The patient has had the colostomy since 2006 without problems but the son said she had a recent hospitalization “…and people were poking stuff in there…” Unfortunately, there aren’t any Ostomy nurses within 200 miles…

Another thought…if the area does not improve with the above modifications, consider sending the patient to a colorectal surgeon…the patient may have a malignancy or some other abnormality that would require a biopsy.

We advised that if she wasn’t better in a couple of days on atb, or if she worsened at at any time she should fu with her surgeon. The ED physician talked to the surgeon on the phone. Just wondering if there were any ideas for minimizing contamination of the open area.

Unfortunately, the site will always be"contaminated"...it's stool after all...there are no sealants over an erosion on the stoma that I am aware of...only hemostatic agents...which will stop bleeding but not prevent "contamination". I guess one could consider gut decontamination with antibiotics....but this would carry risks. If the patient is septic and one believes that the erosion is the portal of entry, an ID consult should be considered. Also, send a pic or doing a live televisit showing the surgeon and the ostomy nurse the erosion can also be helpful.

Thanks! I always appreciate your prompt replies and ideas.