Purpose: The present study aimed to identify factors associated with clinical path (CP) deviation in patients who underwent stoma surgery using its CP.

Methods: The subjects were patients who underwent lower gastrointestinal surgery with stoma formation, for which its CP was applied, between January 2019 and March 2022. They were retrospectively reviewed, and their independent risk factors for CP deviation were identified by multivariate analysis comparing the CP deviant and non-deviant groups. CP deviation was defined as hospitalization for more than 10 postoperative days. A similar analysis was performed for prolonged hospitalization defined as hospitalization for 17 or more postoperative days.

Results: A total of 78 patients (median age 68 years, 51 males) were reviewed. CP deviation was seen in 62 (79.5%) patients, and their independent risk factors were postoperative complications, unemployment, and stool leakage from the stoma bag. Prolonged hospitalization was seen in 24 (30.8%) patients, and their independent risk factors included open surgery, postoperative complications, stoma complications, and stool leakage from the stoma bag.

Conclusion: To shorten hospitalization duration, attention should be paid to postoperative complications, as well as to educate patients about stoma selfcare taking into account stoma complications and stool leakage from the stoma bag. Because the CP deviation rate was high in our hospital, revision and improvement to our CP itself, including the allowed number of postoperative days for hospitalization, might be necessary.

Purpose: The present study aimed to elucidate the measures currently in place at municipal offices and ostomy supply shops in Nagano Prefecture to support disaster preparation for ostomates.

Methods: A questionnaire survey was conducted by postal mail on 77 municipal offices and 7 ostomy supply shops in Nagano Prefecture.

Results: Completed survey forms were received from 32 municipal offices (41.6%) and 6 ostomy supply shops (85.7%). Although 96.9% of municipal offices were aware of the existence of welfare support shelters, 71.9% of them had not held any meetings about disaster preparation with the shelters, and 53.1% of them had not participated in disaster response drills organized by the shelters. Only 3.1% of municipal offices maintained a stock of ostomy supplies, expecting ostomates to be responsible for their own supplies. Furthermore, 84.4% of municipal offices were unaware of the Ostomy Appliance Safety net group (OAS). Regarding ostomy supply shops, 66.7% of them had collaborated with hospitals and 50.0% had collaborated with municipal offices. Half of ostomy supply shops were unaware of the OAS. As for contact information to be provided to ostomates during a disaster, both municipal offices and ostomy supply shops had specific reasons to provide information on different types of facilities; consequently, they did not provide the same contact information.

Municipal offices requested information on ostomate support counters, while ostomy supply shops requested information on facilities where wound, ostomy, and continence nurses (WOCNs) are stationed. All ostomy supply shops indicated a desire for a map showing the locations of WOCNs.

Conclusion: Collaboration and mutual awareness among municipal offices, welfare support shelters, ostomy supply shops, and WOCNs, which are necessary to properly support ostomates in disasters, were found to be still insufficient.

Purpose: The present study aimed to visualize information regarding support counters for ostomates by developing a map using a geographic information system (GIS).

Methods: The purpose of this study was explained using consent forms, and completed consent forms were received from seven ostomy supply shops in Nagano Prefecture that were investigated in 2019, certified wound, ostomy and continence nurses (WOCNs), and disaster base hospitals listed on the official website of Nagano Prefecture. The use of GIS technology to develop a map, especially for geospatial information, was explained to participants, and location information for ostomy supply shops, ostomy support counters, and disaster base hospitals was input into the GIS.

Results: The location information of seven ostomy supply shops, 30 ostomy support counters, and ten disaster base hospitals in Nagano Prefecture was input into the GIS map. The created map was titled “Ostomy Support Information” and published on the official website of Nagano Prefecture.

Conclusion: A GIS map of “Ostomy Support Information” was developed and is now available on the official website of Nagano Prefecture. This map is expected to be used as an information source for ostomates, as well as a tool for collaboration and cooperation among municipal offices, ostomy supply shops and WOCNs, not only during disasters but also under normal conditions.

Background: Fecal incontinence (FI) can impair quality of life (QOL). A case of a patient with neurogenic bowel dysfunction whose FI was effectively managed by transanal irrigation (TAI), which also improved his QOL, is reported.

Case: A man in his 50s developed urinary incontinence and FI due to cauda equina syndrome after surgery for lumbar spondylolisthesis. TAI was started to treat FI after pharmacotherapy failed. A visual analogue scale (VAS, 0:worst - 10:best) was used to evaluate his satisfaction regarding bowel symptoms and management. His FI improved dramatically with TAI, and his VAS score also increased markedly, from 2.3 to 10 after TAI. His frequency of visiting the toilet due to anxiety about FI, as well as the time spent worrying about FI, also decreased markedly. He looked gloomy before TAI, but he became bright and cheerful in his appearance after TAI, being able to live without FI. He learned to talk positively about TAI, saying “I feel like coming home early to perform TAI on the day for it,” and “My urination has also become better thanks to TAI”.

Conclusion: TAI improved FI and QOL in a patient with neurogenic bowel dysfunction due to cauda equina syndrome.

Background: Stomal perforation often requires relocation of the stoma with laparotomy, but it is difficult to resect and reform the stoma at the same time. A case of stomal perforation of parietal portion type treated by local surgery to avoid stoma relocation by laparotomy is reported.

Case: A 77-year-old woman with an end colostomy after Hartmann's operation for perforated sigmoid diverticulosis visited her previous doctor with complaints of peristomal distention and pain. Abdominal computed tomography showed retention of feces and free air under peristomal skin. She was diagnosed as having stomal perforation and referred to our hospital for emergency surgery. An incision was made into peristomal skin to remove the feces, and intestinal perforation was found in the parietal portion of the stomal limb. She had a parastomal hernia and abdominal fascia dehiscence, but the peritoneum was preserved, so fecal contamination was localized to within the abdominal wall without peritonitis. The perforated intestine was excised, and the colostomy was reformed, preserving the stomal limb. The patient was discharged on day 38 of hospitalization after postoperative treatment with antibiotics and management by subcutaneous drainage.

Conclusion: In cases of stomal perforation of parietal portion type without peritonitis, it is possible to avoid laparotomy to reform the stoma in the acute phase by performing local drainage and a stoma reformation technique to preserve the stoma limb.