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Teachable Moment
Less Is More
January 2017

Thinking Beyond the OstomyA Teachable Moment

Author Affiliations
  • 1University of Pittsburgh Medical Center, Presbyterian-Montefiore Hospital, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2New York Medical Center, Metropolitan Hospital Center, formerly Internal, Medicine Resident at University of Pittsburgh Medical Center, New York
  • 3General Internal Medicine, University of Chicago, Chicago, Illinois
JAMA Intern Med. 2017;177(1):13-14. doi:10.1001/jamainternmed.2016.6868

A 53-year-old white man with Crohn disease and multiple previous surgeries, including a total proctocolectomy with end-ileostomy in 2001, presented with ileostomy bag dysfunction. He was sent to an academic medical center for further stoma evaluation and ileostomy care. He had returned to urgent care twice that week with complaints of the bag leaking stool due to improper attachment and causing skin irritation at the site. On review of his medical record, he had been admitted 3 times in the last 4 months for the same issue. Each admission, evaluation of his stoma yielded no abnormal findings by gastroenterology, enterostomal therapy, or surgical services. During a prior hospitalization, behavioral health was asked to see the patient due to his unusual preoccupation with his stoma bags. He was diagnosed as having generalized anxiety disorder and had been started on a serotonin reuptake inhibitor, but he continued to have difficulty caring for the ostomy.

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