Pediatric emergency medicine trisk 4684 4684

Many vesicostomies are colonized with bacteria via stomal contamination Therefore, a catheterized specimen through the stoma is sometimes unreliable Patients with constitutional symptoms such as fever should have their urine culture carried out via vesicostomy If no other source of fever is discovered, treatment should commence after the culture has been obtained In an asymptomatic patient, a positive culture result may represent asymptomatic bacteriuria and is not always of concern Skin irritation in the area of the vesicostomy is unusual The most important preventive measure is frequent diaper changes, even if highly absorbent diapers are used If urine seeps onto the patient’s clothes repetitively, skin breakdown may ensue In severe cases, temporary urinary diversion with a Foley catheter while applying a barrier ointment allows time for healing Ureterostomy Stenosis is the most common complication in the patient with a ureterostomy These patients often present with fever and symptoms suggestive of pyelonephritis The stoma should be catheterized with an 8F catheter, and urine should be sent for culture Surgical revision of the stoma or definitive urologic reconstruction must be considered Ureterostomy prolapse is rare Ileal Loop Conduits Inflammation of the peristomal skin arises when the appliance fits poorly around this bud of ileum, allowing urine to seep under the protective wafer Prolonged contact with skin causes irritation and ulceration The use of paste to create a better seal around the bud is often all that is needed to avoid such a complication In some cases, surgical revision is necessary, especially when the bud has retracted Prolapse of the ileum occurs occasionally and can be striking, especially if too long a segment was used in creating the loop initially Prolapsed segments 20 to 30 cm H2 O long have been seen and require surgical revision If the prolapse is minor, the clinician should perform the same gentle manual reduction technique previously described in the “Stomal Complications” section under “Gastrointestinal Diversions.” Peristomal hernia can occur when fascial defects adjacent to the ileal loop allow loops of bowel to herniate outside the abdominal wall This condition requires urgent surgical consultation Stenosis of the ileal stoma may occur in these patients Symptoms may include pain, but the usual presenting complaint for these patients is fever This finding