Management of a Complex Peristomal Calciphylaxis: A Case Study

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Abstract

BACKGROUND:

Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare and serious syndrome of small blood vessels with a high mortality rate. Calciphylaxis lesions require intensive wound management with medical interventions for the patient to survive the sequelae of sepsis and present unique challenges when found in the peristomal skin.

CASE:

A 33-year-old man presented with multiple malodorous stage 4 pressure injuries of his sacrococcygeal and gluteal area. His medical history included chronic kidney disease requiring hemodialysis since 2007, diabetes mellitus, and incomplete paraplegia. He underwent diverting colostomy to enhance wound healing. His hospital stay was complicated by the development of a peristomal calciphylaxis lesion (PCL) that made ostomy pouching especially challenging for the nursing staff. His care needs were also aggravated by nonadherence to diet restriction, pressure injury prevention efforts, and a continued need for high doses of analgesic medication. Collectively, these issues presented a challenge for the health care team during his hospital course and during safe discharge planning.

CONCLUSIONS:

The peristomal calciphylaxis lesion decreased in surface area and improved in appearance with the use of various wound care products as his medical condition improved. Skilled nursing management in the context of ongoing interdisciplinary collaboration assisted in managing the patient's peristomal calciphylaxis, ultimately leading to safe discharge from hospital.

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