caregivers There is often drainage associated with the granulation tissue; however, this does not uniformly indicate the presence of infection Hypergranulation tissue may begin to cause occlusion of the stoma and should be treated Treatment options include the application of silver nitrate swabs (though this may be uncomfortable to the patient), triamcinolone cream (0.5%) twice a day, and polyurethane foam dressings Cellulitis When peristomal skin surrounding the G-tube or J-tube is irritated by recurrent or intermittent exposure to drainage or other irritants, cellulitis may occur The infection may begin as superficial skin irritation or contact dermatitis and then evolve into a deeper infection The surrounding peristomal area may become reddened, warm, tender, and edematous These symptoms and signs may occasionally be accompanied by systemic symptoms and fever The patient with a G- or J-tube may become resistant to tube feedings because of the discomfort associated with manipulation of the apparatus Once cellulitis is present, the patient requires systemic antibiotics for resolution of this infection The common organisms, staphylococci and streptococci, usually respond to a first-generation cephalosporin Occasionally, a peristomal abscess, heralded by a localized area of fluctuance, can complicate the cellulitis This abscess requires incision and drainage (generally by a surgeon) Fungal Infection Recurrent moisture caused by gastric or jejunal leakage in the stomal area can predispose the patient to fungal infection The most common causal organism is Candida albicans , appearing as fiery red plaques at the stoma site Topical clotrimazole is curative in most situations Keeping the area as dry as possible is imperative to promote healing GASTROINTESTINAL AND GENITOURINARY DIVERSION Background Pediatric patients may have a GI or genitourinary (GU) diversion for one of many reasons Congenital causes include Hirschsprung disease, imperforate anus, cloacal exstrophy, bladder exstrophy, meningomyelocele with a neurogenic bladder, and posterior urethral valves Acquired lesions may include ulcerative colitis, Crohn disease, and necrotizing enterocolitis Traumatic injuries leading to GI or GU diversion include penetrating wounds and falls GI diversions consist primarily of colostomy and ileostomy A colostomy brings the colon to the skin; these patients usually have semi-formed stools