Managing Colostomy Complications After Surgery: A Patient's Journey

After undergoing a colostomy, a fistula developed in the abdomen?

I have undergone major surgery, resulting in 100% intestinal adhesions, and I had my stomach and duodenum removed, followed by a bypass surgery.
Eighteen years after the surgery, I had to undergo another operation due to a fistula in my abdomen, which initially caused a significant amount of stool to leak.
The previous wound was deep and large, and much of the stool was sticking to the ostomy pouch.
After being discharged, I was readmitted and taken to the operating room to suture the wound, but over a month later, the fistula is still leaking stool, and the output is increasing.
The "photo" shows that after changing the gray gauze in the morning, it became saturated again in less than an hour.
The doctor mentioned that it would heal on its own and that the depth is now only 0.2 cm, but the stool output is increasing.
Will this heal on its own, or will I have to live with this for the rest of my life? Do I need another surgical procedure to close the fistula? I am experiencing pain daily due to the granulation tissue breaking and the skin breaking down, and the stool leaking for too long causes significant redness and swelling on the skin, with some areas breaking open.
Is it okay to apply artificial skin to the broken areas? Or should I use ostomy powder instead? I believe I might be one of the few cases like this.
I hope a doctor can help me with these questions.
Thank you.

Miao Miao, 40~49 year old female. Ask Date: 2021/06/29

Dr. Xu Kaixi reply Surgery

Based on your description, it seems you have undergone surgery for an abdominal wall hernia, which has resulted in a fistula between the intestine and the abdominal wall as well as the skin.
In some severe abdominal surgeries, there is indeed a small percentage of cases that may develop such fistulas.
The gastrointestinal tract secretes over a thousand cc of intestinal fluid (which you described as stool) daily, and part of this fluid may leak out through the fistula.
Due to the differing pH levels of these intestinal fluids, skin irritation and breakdown can occur in the surrounding area.
Therefore, you can use the artificial skin, stoma powder, or related stoma protective dressings you mentioned to protect the skin.
The treatment approach should be evaluated based on the clinical condition and relevant imaging studies, and it usually requires surgical intervention.
If necessary, hospitalization with fasting and nutritional support may be needed.
It is advisable to discuss this further with your original surgeon.

Reply Date: 2021/06/29

More Info

Managing complications after a colostomy can be a challenging journey, especially when dealing with issues like fecal leakage and skin irritation. Based on your description, it seems that you are experiencing significant complications following your surgery, including a persistent fistula (an abnormal connection between the bowel and the skin) that is causing fecal matter to leak out, leading to discomfort and skin breakdown.

Firstly, it is important to understand that while some fistulas can heal on their own, many require medical intervention, especially if they are producing a significant amount of output. The fact that your wound is still leaking fecal matter after a month suggests that it may not be healing as expected. The depth of the wound being only 0.2 cm is a positive sign, but the ongoing leakage indicates that the healing process is not complete. It is crucial to follow up with your healthcare provider to assess the situation further. They may consider additional treatments or surgical options to close the fistula if it does not heal on its own.

In terms of managing the output and protecting your skin, there are several strategies you can employ. Using barrier creams or powders specifically designed for ostomy care can help protect your skin from the corrosive effects of stool. These products create a protective layer that can reduce irritation and promote healing. Additionally, using hydrocolloid dressings or artificial skin can provide a barrier that helps to manage moisture and protect the skin from breakdown.

It is also essential to maintain good hygiene around the stoma and the surrounding skin. Regularly changing the dressing and cleaning the area can help prevent infection and further irritation. If you notice any signs of infection, such as increased redness, swelling, or discharge, it is important to contact your healthcare provider promptly.

Regarding your concern about whether you will have to live with this condition permanently, it is difficult to provide a definitive answer without a thorough examination by a healthcare professional. Some patients do experience long-term complications, while others may find that their fistulas close with time and appropriate care. Continuous communication with your healthcare team is vital to ensure that you are receiving the best possible care and to explore all available options for treatment.

In summary, while it is possible for some fistulas to heal on their own, your ongoing symptoms suggest that further evaluation and possibly intervention may be necessary. Protecting your skin, maintaining hygiene, and following up with your healthcare provider are crucial steps in managing your condition. If you have not already done so, consider seeking a second opinion or consulting a specialist in ostomy care or colorectal surgery for additional guidance. Your quality of life is important, and there are resources and treatments available to help you navigate this challenging situation.

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