Authors (including presenting author) :
HO CW(1), Lam YH(1), Chan KH Sharon(1), Chan WH(1); Lau CW(1), Lai CH Eric(1)
Affiliation :
(1) Department of Surgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
Most often the skin granuloma is caused by fecal irritants, friction from the base plate or the stoma is fashioned to be flat in appearance. Patients often need admission for unnecessary blood transfusion and hospitalization.
Objectives :
This case report describes the local ligation of series cases of extensive mucocutaneous skin granuloma for patients with enterostomy presented frequently stomal bleeding.
Methodology :
During July 2020 till May 2021; local ligation started to manage the mucocutaneous skin granuloma; total 10 patients recruited plus the informed consent. Followed the physical assessment of granuloma by size; nature; structure and presence of stalk. The size ranged from 2mm to 30mm. Number of granuloma varied from 1 to 16. Before procedures; the stoma needed skin preparation and washed by normal saline. The stoma mucosa and all affected granulomas were stained by the fluorescence strip with 0.9% 10ml normal saline, the local bleeders and nature could be carefully visualized. After fluorescence diagnostics, all affected skin-granuloma were treated by local ligation with 4/O Vicryl stitches.
Result & Outcome :
After ligation 70% patients reported the stoma bleeding minimized in the first 24 hours. In next 24-48 hours, 90% patients reported the bleeding were largely resolved. Lastly; the stoma appearance and granuloma removal plus stalk clearance improved by 85% and 87% respectively. Incidentally, there are 2 patients who need to be referred to colorectal surgeon for the granuloma biopsy are malignant. Local ligation highly depends on suturing skills and instrument handling. The clinical success depends on the collaboration and partnership between principal nurse and scrub nurse. Beyond that, the frequent episode of bleeding painful skin granuloma let us reform the evidence based stoma care and assessment protocol. In advanced nursing practice, ligation is a non-invasive and fast responsive nursing intervention to treat the acute symptoms of mucocutaneous skin granuloma. Promotion of the clinical outcomes of this nursing intervention is necessary and the ligation techniques warrant further assessment among clinicians. Based on the clinical evidence of ligation techniques; we are going to explore the algorithms for treatment of extensive mucocutaneous skin granulomas in the near future.
