EP474 - CellerateRX As Adjunct for Healing Peristomal Abscess

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Purpose/Background: Peristomal abscesses are an uncommon early complication after ostomy creation. The etiology is usually from intraoperative seeding of enteric flora during creation or from preoperative colonization of the skin not eradicated by the chlorhexidine skin prep. Typically these are treated with incision and drainage, though they are often complicated by recurrence and can even require stomal relocation. In this report, we describe a case where peristomal abscess was successfully treated with serial wound vac application and use of CellerateRX, a hydrolyzed collagen used to provide a framework for collagen deposition, which ensures wound growth with minimal contraction and scar tissue.

Methods/Interventions: A 44 year old female presented s/p subtotal colectomy with ileorectal anastomosis for juvenile polyposis in her 20s, followed by robotic abdominoperineal resection, hysterectomy, and end ileostomy for T4N2M0 rectal mucinous carcinoma. At 1 month postop she noted increased pain, erythema, and purulent drainage 1 cm from the ostomy site. She was sent from the clinic to the hospital where the abscess was incised and drained. The cavity was initially packed with calcium alginate. After two days of IV antibiotics and daily repacking of the wound, drainage converted from purulent to serosanguineous. Wound vacuum was placed and the patient was discharged. The patient was seen the following week in outpatient clinic, where cellerateRX hydrolyzed collagen was placed in the abscess cavity and then covered with a wound vacuum. This was repeated for two weeks with wound vacuum dressing followed by packing.

Results/Outcomes: After 6 weeks, the wound had completely healed with minimal scarring, allowing easy placement of the ostomy bag. The patient has since had several months of follow up with no recurrence of the abscess.

Conclusion/Discussion: Literature review shows that peristomal abscesses occur with an incidence of 2-14.8%. These rarely resolve without incision and drainage with subsequent packing or drain placement to allow secondary healing and eventual closure of the cavity. This can be complicated due to the proximity to stool or succus from the ostomy.

In his case, the patient had a large peristomal abscess 1cm from the ostomy resulting in difficulty with ostomy appliance application and high risk for reinfection. We elected to use a wound vacuum initially to ensure drainage while also protecting the site from stool. The application of the hydrolyzed collagen was used off label, as there is not yet an indication in infected wound beds. With the assistance of the wound vacuum to remove the extracellular debris and byproducts of the immune response, the collagen provided a framework for the wound to heal with minimal contraction. This worked well for a simple abscess, however it is to be determined whether this method could be used for a colocutaneous tract, as these often cannot be resolved without stomal relocation.