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Managing severe dermatitis caused by ileal peristomal leakage using a mushroom-type (de Pezzer) catheter in infants:
Seyed Abbas Banani1, Seyed Javad Banani2
1Shiraz University of Medical Sciences (SUMS), Department of Pediatric Surgery, Shiraz, Iran.
Insights
A novel mushroom catheter technique effectively managed severe infant peristomal dermatitis from ileal leakage. This simple procedure improved skin condition and promoted weight gain in infants unresponsive to traditional treatments.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Dermatology
Background:
- Peristomal leakage in infants with ileostomies commonly causes skin damage.
- Conventional treatments like skin barriers and ointments are not always effective.
Purpose of the Study:
- To describe a simple, temporary procedure for managing severe peristomal dermatitis in infants due to ileal leakage.
- To evaluate the efficacy and safety of using a mushroom-type catheter for this condition.
Main Methods:
- A case series involving 11 infants (1-4 months old) with severe peristomal dermatitis.
- Insertion of a mushroom-type (de Pezzer) catheter into the ileostomy after parental informed consent.
Main Results:
- Remarkable improvement in peristomal dermatitis severity within 2-3 days for all patients.
- Minimal dermatitis observed in 8 patients within 5-7 days.
- Improved weight gain in 6 infants with initially poor growth (P <0.03).
- No complications reported during catheter use (2 days to 4 months).
Conclusions:
- A mushroom-type (de Pezzer) catheter is a practical temporary solution for infant ileal peristomal leakage and associated dermatitis.
- This technique is particularly beneficial for infants unresponsive to medical therapy.
- Further research is needed for evidence-based protocols for ileostoma complications in infants.
Abstract:
Skin damage secondary to peristomal leakage is a fairly common complication of ileostomies in infants. Traditional conservative measures, including skin barriers, ointments, and agents to reduce bowel movements, initially may be helpful but not in all patients. The purpose of this case series was to describe a new and relatively simple procedure to temporarily manage severe peristomal dermatitis caused by ileal peristomal leakage in infants. After obtaining informed consent from the parents, a mushroom-type (de Pezzer) catheter was inserted into the ileostomy of 11 1- to 4-month-old infants (seven males, four females) with severe peristomal dermatitis. Eight had total aganglionic colon (TAC), two had meconium ileus (cystic fibrosis), and one had meconium peritonitis due to bowel perforation proximal to ileal atresia. The severity of the peristomal dermatitis improved remarkably in all patients after 2 to 3 days. In eight patients, minimal (if any) dermatitis was noted within 5 to 7 days after tube insertion. Six patients who initially had poor weight gain (mean 345 g/month) developed acceptable weight gain (mean 648 g/month) (P <0.03) within 2 to 4 months. In seven patients with TAC, the tube was maintained for 2 to 4 months until definitive pull-through procedure; in four other patients, the tube remained in place for 3 to 7 days as a step for preoperative build-up. None of the patients developed any complications. The procedure requires the presence of a pediatric or trained surgeon, and care must be taken to prevent iatrogenic damage. In this case series, an appropriate-size, mushroom-type (de Pezzer) catheter placed within the ileostomy was a practical mode for temporary control of ileal peristomal leakage that causes severe peristomal dermatitis in infants, particularly in those not responding to medical therapy. Larger studies are needed to develop evidence-based protocols of care for the prevention and management of ileostoma complications in infants.
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