Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

Diagnosis of Irritant Dermatitis in Colorectal Cancer Postoperative Stoma Patients Using Smartphone Photographs: A Deep Learning Approach

Background

Irritant dermatitis is a common complication among stoma patients, significantly impacting their quality of life. Early diagnosis is essential, but limited access to healthcare and poor self-management skills often delay treatment. This study aimed to assess the effectiveness of two advanced convolutional neural networks (CNNs), ConvNeXt and MobileViT, for the intelligent diagnosis of irritant dermatitis using smartphone-acquired stoma images.

Methods

A retrospective observational study was conducted, collecting 825 stoma complication images from five tertiary hospitals in China. Data preprocessing techniques such as resampling and enhancement were used to prepare the dataset. The ConvNeXt and MobileViT models were trained and evaluated based on accuracy, precision, recall, and F1 scores. Optimizers and learning rates were also adjusted to assess model performance.

Results

ConvNeXt demonstrated superior performance, achieving an accuracy of 71.4%, precision of 73.6%, recall of 67.1%, and an F1 score of 70.2% with the Adam optimizer and a 0.001 learning rate. MobileViT, despite being more lightweight, did not surpass ConvNeXt, with a maximum accuracy of 64.4%. ConvNeXt excelled in diagnosing irritant dermatitis and normal stoma conditions but showed limitations in recognizing other complications.

Conclusion

The ConvNeXt model outperformed MobileViT, indicating that advanced CNNs can effectively assist in the early diagnosis of irritant dermatitis among stoma patients. This could help alleviate the burden on healthcare resources and improve patient outcomes through accessible mobile-based diagnostic tools.

Incidence and impact of peristomal candidiasis on outcomes after intestinal stoma closure: A prospective study

An intestinal stoma is often created to protect a distal anastomosis. Factors affecting morbidity and mortality of stoma closure have been well studied; however, the role of fungal infection in peristomal skin has not. This prospective, observational study was conducted between August 2022 and July 2024 to determine the incidence of fungal infection in peristomal skin, in patients undergoing stoma closure, and its association with postoperative complications such as surgical site infection (SSI), anastomotic-leak, bowel obstruction/ileus and mortality. The incidence of paralytic ileus, bowel obstruction, anastomotic leaks, and mortality were insignificant, but peristomal Candida infection is a significant risk factor for postoperative SSI.

CASTOMized project: a new comprehensive collaborative approach between case manager and stoma care nurse

BACKGROUND

The use of the Enhanced Recovery After Surgery (ERAS) care pathway is becoming more widespread in surgical specialties. However, the presence of an ostomy, and the patient's need to adapt quickly to living with a stoma, is described as the Achilles' heel of the ERAS pathways in colorectal surgery.

AIM

To investigate the efficacy of applying a new patient pathway within the ERAS protocol.

DESIGN

A retrospective observational study.

METHOD

The management of patients undergoing surgery for colorectal disease and stoma formation between January 2023 and December 2023 was reviewed. Two clinical nurse specialists collaborated to integrate interventions and pathways.

FINDINGS

Of the 99 colorectal cancer or inflammatory bowel disease patients included in the study, the stoma care and management for 96 (95.9%) of the group fully adhered to the pathway. A median hospital stay of 11 days was recorded, with an interquartile range of 9 days; 40% of patients were treated as emergency cases. Adherence to the ERAS protocol (nursing care items) was 98%. Most patients were discharged home (91%). Adherence to telephone follow-up decreased over time, but remained above 90%. In the immediate post-discharge period, the percentage of patients with a high-output stoma was established at 15%, with only 3 (3%) of these requiring re-admission.

CONCLUSION

The study highlights the benefits gained by entrusting advanced practice nurses with the integrated management of care pathways in ostomy patients.

Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients: A single center experience

BACKGROUND

Mucocutaneous separation (MCS) is a common postoperative complication in enterostomy patients, potentially leading to significant morbidity. Early identification of risk factors is crucial for preventing this condition. However, predictive models for MCS remain underdeveloped.

AIM

To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.

METHODS

A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study. Patients were divided into two groups, the MCS group (n = 110), and the non-MCS (n = 382) based on the occurrence of MCS within the first 3 weeks after surgery. Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed. Receiver operating characteristic curve analysis was used to assess the model's performance.

RESULTS

The postoperative MCS incidence rate was 22.4%. Suture dislodgement (P < 0.0001), serum albumin level (P < 0.0001), body mass index (BMI) (P = 0.0006), hemoglobin level (P = 0.0409), intestinal rapture (P = 0.0043), incision infection (P < 0.0001), neoadjuvant therapy (P = 0.0432), stoma site (P = 0.0028) and elevated intra-abdominal pressure (P = 0.0395) were potential predictive factors of MCS. Suture dislodgement [P < 0.0001, OR: 28.0075 95%CI: (11.0901-82.1751)], serum albumin level (P = 0.0008, OR: 0.3504, 95%CI: [0.1902-0.6485]), BMI [P = 0.0045, OR: 2.1361, 95%CI: (1.2660-3.6235)], hemoglobin level [P = 0.0269, OR: 0.5164, 95%CI: (0.2881-0.9324)], intestinal rapture [P = 0.0351, OR: 3.0694, 95%CI: (1.0482-8.5558)], incision infection [P = 0.0179, OR: 0.2885, 95%CI: (0.0950-0.7624)] and neoadjuvant therapy [P = 0.0112, OR: 1.9769, 95%CI: (1.1718-3.3690)] were independent predictive factors and included in the model. The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.

CONCLUSION

The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.

Development and Validation of an Artificial Intelligence-Assisted Patient Education Material for Ostomy Patients: A Methodological Study

AIM

To develop and test the validity of an artificial intelligence-assisted patient education material for ostomy patients.

DESIGN

A methodological study.

METHODS

The study was carried out in two main stages and five steps: (1) determining the information needs of ostomy patients, (2) creating educational content, (3) converting the educational content into patient education material, (4) validation of patient education material based on expert review and (5) measuring the readability of the patient education material. We used ChatGPT 4.0 to determine the information needs and create patient education material content, and Publuu Online Flipbook Maker was used to convert the educational content into patient education material. Understandability and applicability scores were assessed using the Patient Education Materials Assessment Tool submitted to 10 expert reviews. The tool inter-rater reliability was determined via the intraclass correlation coefficient. Readability was analysed using the Flesch-Kincaid Grade Level, Gunning Fog Index and Simple Measure of Gobbledygook formula.

RESULTS

The mean Patient Education Materials Assessment Tool understandability score of the patient education material was 81.91%, and the mean Patient Education Materials Assessment Tool actionability score was 85.33%. The scores for the readability indicators were calculated to be Flesch-Kincaid Grade Level: 8.53, Gunning Fog: 10.9 and Simple Measure of Gobbledygook: 7.99.

CONCLUSIONS

The AI-assisted patient education material for ostomy patients provided accurate information with understandable and actionable responses to patients, but is at a high reading level for patients.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Artificial intelligence-assisted patient education materials can significantly increase patient information rates in the health system regarding ease of practice. Artificial intelligence is currently not an option for creating patient education material, and their impact on the patient is not fully known.

REPORTING METHOD

The study followed the STROBE checklist guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

Course and predictors of supportive care needs among colorectal cancer survivors with ostomies: a longitudinal study

PURPOSE

Although there is a growing emphasis on supportive care for cancer patients, those with colorectal cancer (CRC) who have ostomies require special attention in terms of their physical, psychological, spiritual, and social needs. However, there has been a lack of significant progress in meeting the supportive care needs of CRC survivors with ostomies. To bridge this gap, we conducted a prospective longitudinal study to track the trends in supportive care needs among CRC survivors with ostomies and identify any predictors over 6-month period.

METHODS

A prospective longitudinal study was conducted at the wound and stoma clinic of Dalian University Affiliated Xinhua Hospital, focusing on CRC survivors with ostomies. A total of 143 participants completed self-report questionnaires on the 34-item Short-Form Supportive Care Needs Survey (SCNS-SF34-C (Mandarin)) and stoma complications at the first, third, and sixth month after surgery. ANOVA with repeated measure was utilized to assess the course of supportive care needs, with Generalized Estimating Equation (GEE) applied to identify predictors of SCNS.

RESULTS

The supportive care needs and five dimensions scores were statistically significant at three time points (P < 0.05). The ratings of patients at the first, third, and sixth month after surgery revealed a decreasing trend in the scores for patient care and support, psychological needs, physical and daily living needs, and health system and information needs. However, the score for sexual needs showed an increased tendency. Higher levels supportive care needs were generally connected with a short duration after ostomy, high income level, resident medical insurance, spouse caregiver, other chronic disease, and stoma complications.

CONCLUSIONS

Survivors' supportive care needs showed a dynamic trend over 6 months after surgery. Through three rounds, the primary needs were health system and information needs. It is recommended to integrate interdisciplinary health professionals and establish a comprehensive support and care system to effectively meet the diverse needs at different stages. Priority should be given to individuals with ostomies during the first and third month after surgery, particularly those with higher income levels, employee medical insurance, spouse caregivers, other chronic diseases, and stoma complications.

Peristomal skin care: seeking the solution to maintain skin integrity?

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients.

Surgical outcomes and stoma-related complications in inflammatory bowel disease in Saudi Arabia: a retrospective study

BACKGROUND

The prevalence of inflammatory bowel diseases (IBD), Crohn's (C) and ulcerative colitis (UC) has increased in Saudi Arabia during the past decade. Even though medical treatment is first-line therapy, most patients require surgery during the course of the disease. Stoma creation complications in IBD are underreported in the literature of the Middle East and especially in Saudi Arabia.

OBJECTIVES

Report the postoperative, stoma and peristomal complications following stoma creation in (C) versus UC.

DESIGN

Retrospective cohort study.

SETTINGS

Tertiary care center.

PATIENTS AND METHODS

Patients with IBD who underwent stoma creation for either UC or CD between August 2015 and July 2020 were included. The diseases were compared to assess their characteristics and association to postoperative, stoma and peristomal complications. All complications were reported over a 90-day duration from the surgery. Patients younger than 14 years of age were excluded.

MAIN OUTCOME MEASURES

Postoperative complications, stoma and peristomal complications in IBD patients who underwent stoma creation.

SAMPLE SIZE

50.

RESULTS

Of 50 IBD patients underwent stoma creation, 32 patients (64%) were diagnosed with CD and 18 patients (36%) with UC. Most of the procedures in both groups were laparoscopic and elective. Low BMI and serum albumin were more prevalent in the CD group. Postoperative complications were higher in the CD patients compared to the UC patients (CD 40.6% vs UC 11.1%, P=.028) with the most common complication being abdominal collection[a]. Stoma complications were comparable between the two groups (UC 16.7% vs CD 15.6%). However, peristomal complications were higher clinically in UC patients in comparison with the CD patients (UC 61.1% vs CD 37.5% P=.095) with the most common complication being skin excoriation (UC 44.4% vs CD 37.5%).

CONCLUSIONS

CD has significantly higher postoperative complications compared to UC. Peristomal complications were high in both groups and had a negative impact on quality of life. Therefore, comprehensive stoma education and regular outpatient follow ups are recommended to improve the overall outcomes.

LIMITATIONS

Retrospective and conducted in one academic institution with a small sample size.

Peristomal Skin Complications: Detailed Analysis of a Web-Based Survey and Predictive Risk Factors

Patients with a stoma are at risk of developing peristomal skin complications (PSCs) that can negatively impact their quality of life. This study aims to identify potential risk factors for dermatitis, pruritis/xerosis, infections, and ulcerations among patients with a stoma and evaluate preventive measures. This cross-sectional study involved data regarding 232 Italian patients with a stoma. A questionnaire was used to collect patient characteristics, comorbidities, and stoma management data. The most frequent PSCs observed were dermatitis and pruritis/xerosis in approximately 60% of patients. Psoriasis was strongly correlated with dermatitis, while being overweight or obese increased the risk of pruritis/xerosis. Class 2 obesity and atopic dermatitis were associated with an increased risk of infections. Being underweight, completely nonautonomous, and having inflammatory bowel disease were associated with a higher risk of ulcerations, while radiotherapy was a strong risk factor for ulceration. Preventive measures such as using hydrocolloid barriers, TNT gauze cleansing, and low pH detergent were effective in preventing dermatitis. Appropriate stoma care and maintenance, including the use of protective film and careful monitoring of weight and comorbidities, are crucial in minimizing the risk of complications associated with a stoma.

Peristomal Pseudoverrucous Lesions: A Rare Skin Complication of Colostomy

A 56-year-old female patient with colostomy presented with skin-colored cobblestone and verrucous asymptomatic papules on her peristomal skin for three months; she was referred to dermatology. Histopathology revealed irregular acanthosis, tongue-like extension of rete ridges of mature squamous epithelium without atypical morphology, hyperkeratosis, and inflammation of the skin. The histopathologic appearance was evaluated as compatible with pseudoepitheliomatous hyperplasia. No signs of malignancy, fungus, or koilocytes were found. The lesions were diagnosed as pseudoepitheliomatous hyperplasia by clinical and histopathologic findings. In this case report, we review pseudoepitheliomatous hyperplasia associated with colostomy.