3. CHIEF COMPLAINTS
• Patient came to OPD for follow up for stoma closure.
• c/o redness and itching in skin around stoma since 2 weeks.
4. HISTORYOF PRESENTING ILLNESS
• Patient was apparently well 2 months back when he was admitted to NSCB MCH,
Jabalpur with complaints of acute abdominal pain & vomitting and was found to
have perforation peritonitis for which emergency exploratory laparotomy was
done and stoma was created.
• At present stoma is well functioning with daily output of about 500ml of semisolid
faeces.
• Patient complains of redness and itching over skin around stoma ,which was
insidious in onset , developed after the stoma bag was accidentally removed 2
weeks back.Initially it progressed for few days and then gradually starts subsiding
after topical application of ointment.
5. Continued….
• No c/o abdominal pain, distension and vomitting.
• No c/o pain and bulging at stoma site.
• No c/o bleeding from stoma.
• No c/o change in colour of stoma.
• No c/o altered stoma output.
• No c/o excessive thirst or dryness of mouth.
• No c/o protrusion or retraction of stoma on change of posture.
6. Local Examination
• INSPECTION
• An exteriorised loop of bowel of size 4*3 cm with two visible
openings in right iliac fossa present , 4cm lateral to umbilicus, on
spino-umbilical line.
• Stoma is protruding 2.5 cm above skin surface.
• Visible peristalsis present with Semisolid effluent is coming out
from upper opening.
• Mucosa is pink and healthy with circular folds.
• Skin around the stoma near proximal opening is excoriated. Rest
of the surrounding skin is smooth, healthy and dry. No
peristomal sinuses, bulging or discharge seen.
• No prolapse, retraction or visible cough impulse seen.
• A vertical linear scar mark of size 12 cm of previous exploratory
laparotomy present in midline on both sides of umbilicus.
7. Examination ….
• PALPATION
• No local rise of temperature,no tenderness.
• Loop stoma of size 4*3 cm with two openings in right iliac fossa , 4cm lateral to umbilicus, on spino-
umbilical line.
• Stoma is protruding 2.5 cm above skin surface.Mucosa is smooth , healthy and dry .
• Both openings allow introduction of index finger easily. Soft ,semisolid, green coloured faecal matter
present in upper opening of stoma.
• No stenosis,no growth, no bleeding present on digital examination of both openings.
• Skin around the stoma near proximal opening is excoriated with healthy granulation tissue
present.Rest of the surrounding skin is smooth, healthy and dry.
• No cough impulse , no peristomal hernia present.
• Abdomen is soft, non-tender with a vertical scar mark of size 12 cm present in midline on both sides of
umbilicus.The scar mark is healthy and non-tender.
8. Diagnosis
• My provisional diagnosis is temporary diverting loop ileostomy in right iliac fossa
with peristomal excoriation.
