Management of STOMA complications
#AIBD2021 @IBDConference #GITwitter #surgery #surgerytwitter @pakotze
#AIBD2021 @IBDConference #GITwitter #surgery #surgerytwitter @pakotze
@Marylandibddoc: need to investigate the stoma.
@PhilFleshnerMD: this is recurrent disease until proven otherwise. Needs to be interrogated with scope.
@GutlessGlamour: Stoma issues cause significant psychosocial issues. Close contact with clinical team (GI, ostomy RN) is key๐
@PhilFleshnerMD: this is recurrent disease until proven otherwise. Needs to be interrogated with scope.
@GutlessGlamour: Stoma issues cause significant psychosocial issues. Close contact with clinical team (GI, ostomy RN) is key๐
@PhilFleshnerMD: This stoma needs to be revised. If not local, will need to go through incisional hernia. (And if hernia is causing problems, fix at same time.) Consider completion proctectomy.
Assess disease activity!
#JaniceColwell (ostomy RN): Flush with skin. Overgrowth at mucocutaneous junction. Reaction to product.
@GutlessGlamour: "When I look at that picture, I see pain, I see a lot of pain." "Remember to exude compassion b/c this is a lot to deal with mentally, physically, socially."
@GutlessGlamour: "When I look at that picture, I see pain, I see a lot of pain." "Remember to exude compassion b/c this is a lot to deal with mentally, physically, socially."
@GutlessGlamour: connect with mental health resources ๐ง and connect patients with other patients ๐ค
@Marylandibddoc: patients need to communicate with stoma RN.
@JasonFrischerMD: effective stoma is very important functional outcome in pediatrics.
@Marylandibddoc: patients need to communicate with stoma RN.
@JasonFrischerMD: effective stoma is very important functional outcome in pediatrics.
@GutlessGlamour: We need to change the narrative surrounding surgery and ostomy. It's not just last resort.
@JasonFrischerMD: very challenging especially with teenaged girls, but seeing more acceptance!
@JasonFrischerMD: very challenging especially with teenaged girls, but seeing more acceptance!
Multidisciplinary care
#JaniceColwell: This is peristomal pyoderma gangrenosum. Need #IBD team to assess. Wihle we have topical options, this is a systemic issue.
@GutlessGlamour: โ ๏ธThe patient didn't fail biologics; biologics failed the patientโ๏ธ
@Marylandibddoc: Why didn't the medications work?
@GutlessGlamour: โ ๏ธThe patient didn't fail biologics; biologics failed the patientโ๏ธ
@Marylandibddoc: Why didn't the medications work?
@Marylandibddoc: Will probably need steroids and immunosuppression (systemic cyclosporine, tacrolimus). Get #dermatology.
@PhilFleshnerMD: Do not biopsyโ๏ธPathergy.๐ฅ๐ฅ๐ฅ This is usually driven by luminal disease. Consider removing rectum with ultra-low Hartmann.
@PhilFleshnerMD: Do not biopsyโ๏ธPathergy.๐ฅ๐ฅ๐ฅ This is usually driven by luminal disease. Consider removing rectum with ultra-low Hartmann.
Hyperbaric oxygen helped but no healing.
@GutlessGlamour: If changing stoma bag 1-2x/d, something is wrong. ๐จ
@Marylandibddoc: Need to reconsider anti-TNF in combination with thiopurine. Get level after rechallenge (2nd infusion). Consider po tacrolimus, cyclosporine.
@GutlessGlamour: If changing stoma bag 1-2x/d, something is wrong. ๐จ
@Marylandibddoc: Need to reconsider anti-TNF in combination with thiopurine. Get level after rechallenge (2nd infusion). Consider po tacrolimus, cyclosporine.
@JasonFrischerMD: really need to consider removing as much endoluminal disease as possible. Completion proctectomy needs to be considered.
#JaniceColwell: good seal is important.
#JaniceColwell: good seal is important.
#teamworkmakesthedreamwork: GI, #surgery, #dermatology, patient, ostomy RN
Optimize medical therapy
Hyperbaric oxygen
Optimize medical therapy
Hyperbaric oxygen
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