Emergency Cases Northwest Group

048 Do The Hole Examination

Situation

Missed parastomal hernia.

Background

Patient with a stoma had abdominal pain, referred to surgeons. No acute diagnosis but note made of incidental parastomal hernia, not picked up in the ED.

Assessment

The stoma was inadequately examined n ED.

Recommendation

Remember to examine a stoma and how to do it:

Inspection [if possible ask the patient to remove the stoma bag]:

Where in the abdomen is it?

Does it have a spout?

How many lumens?

What's the effluent like?

Look for herniation, prolapse, retraction and infarction

Look at the surrounding skin for irritation, ulcers and fistulas

Palpation:

Around the stoma for tenderness or herniation

Look for cough impulse

https://teachmesurgery.com/examinations/gastrointestinal/stoma/

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group