We herein present 5 cases with recurrent stomal variceal hemorrhage. The ages of these patients averaged 60.2±8.8 years (range 50˜67 years). The initial hemorrhage from these stomal varices occurs at 3 years 3 months±3 years 5 months average (range 50 days ˜ 9 years). We undertook temporary hemostasis by stomal manipulation in all patients. We used several methods for hemostasis of variceal bleeding ： phenol injection sclerotherapy in four cases, suture ligation in three cases, ligation with rubber ring in 2 cases, and embolization of splenic artery in one case. ln patients with alcoholic liver cirrhosis liver function were improved, stomal varices were improved by abstinence, and bleeding was prevented. We provided innovative stomal care by using 2 colostomy devices with a larger hole cut and a paste-type skin barrier to prevent stomal irritation.

View full abstract

At acute hospitals, efforts are made to shorten hospital stays by utilizing critical pass, but in some circumstances, variance is high, which means that critical pass is inapplicable in areas where a high proportion of the people are elderly. Patients must either be discharged with a home care support system or transferred to a secondary hospital where they can be rehabilitated to a stable condition. As such, patient discharge must be backed up by the network of community cooperation at each level of the medical institution. Unfortunately, in some circumstances, staff members at a secondary hospital reject patients who require specific care, on the ground that they lack the knowledge and experience necessary to provide that care. These problematic situations could be effectively resolved if patients were admitted to secondary institutions with complete and specific patient care information. Visualization of actual care on a DVD was found to effectively relay patient care information to the secondary institution as they were able to image actual care procedures.

View full abstract

This report identifies the incidence of and circumstances surrounding early complications following ostomy surgery and discusses related problems. Sixty-eight patients who underwent ostomy surgery from March 2008 to September 2009 were studied. Early complications were seen in 55 of the 68 cases(80.9％). However, when peristomal dermatitis was excluded, early complications were noted in 29 of the 68 cases (42.6％). Early complications, such as peristomal dermatitis, mucocutaneous detachment, peristomal abscess, stomal necrosis, and peristomal fistula, occurred in 54.4％, 42.6％, 5.9％, 1.5％ and 1.5％ cases, respectively. Peristomal dermatitis and mucocutaneous detachment accounted for a majority of the complications. The height of the stomal orifice from the skin (HSO) was lower in stomas associated with early complications (p＜0.05). High incidences of mucocutaneous detachment were observed with ileostomy, loop stoma, and ulcerative colitis. Ensuring adequate HSO is important for preventing peristomal dermatitis. In addition, since mucocutaneous detachment occurs at a high frequency, it is imperative to ensure proper mucocutaneous suturing with an emphasis on preventing mucocutaneous detachment.

View full abstract

We report two cases of metastatic papillary adenocarcinoma to the peristomal skin. Both cases exhibited raised lesions of variable size around the stoma. A pouch was placed effectively by obtaining a flat surface around the stoma using a moldable skin barrier. Metronidazole was effective for odor control. Due to the poor prognosis, management of metastatic disease to the peristomal skin requires a multidisciplinary approach, including an ostomy outpatient clinic.

View full abstract

Objective ： Excreted watery stool or leaked gastrointestinal juice with digestive enzymes over skin may cause marked flare and sores. Sodium azulene sulfonate ointment（CMC ointment）added with carboxyl methyl cellulose（CMCNa）to increase viscosity was applied on damaged skin to reduce pain and dermopathy.
Methods ： Three different concentration ratio of CMCNa to CMC ointment mixture were applied to 4cases with complicated excretory process.
Results ： Satisfactory recovery of dermopathy and pain ware observed in every 4cases.
Discussion ； This CMC ointment showed remarkable healing effect. Further investigation is required to set best concentration ratio of the CMC ointment / CMCNa mixture to various excretory situations.

View full abstract