Stoma Care - The treatment/removal of stomal and peristomal granulomas using local anaesthetic and curette and cautery

What is a granuloma?

Granulomas are very common lesions/papules that can grow on the surface of a stoma, but more commonly at the junction where the bowel joins the skin on the abdomen.

We know that faecal irritation is the main cause for growth.

Granulomas can be extremely painful and can bleed very easily making it difficult for a new appliance to adhere to the skin.

This impact can have a profound effect on your confidence and quality of life.

What the procedure will involve?

Prior to the procedure, your stoma nurse may have tried topical intervention or pouch modification in an attempt to reduce or eradicate the granuloma.

If all have been unsuccessful, then the treatment of curette and cautery will be offered to you.

This treatment involves

• You will be asked to adopt a comfortable position on the treatment bed and to remove your stoma appliance. We can assist you with this task. The stoma will be cleansed and assessed prior to the anaesthetic injection. Please ensure that you bring your preferred appliances and equipment with you to the appointment
• A small injection of local anaesthetic (Lidocaine 1% with adrenaline 1:200:000) will be injected into the skin tissue at the granuloma site. This will be uncomfortable for only a couple of seconds, after the anaesthetic is injected, the whole area surrounding the stoma will be numb and de-sensitised, allowing you to relax whilst the procedure is carried out
• The consultant or specifically trained stoma nurse will check first that you feel no discomfort and then commence treatment, with a sharp curette the granuloma is removed. This may be collected in a specimen jar and sent for histology (analysis) if needed
• As an incision has been made, the area will bleed. To stop the bleeding the area is cauterised (blood vessels sealed) using an instrument the size of a large pen, called a Hyfrecator. This cauterises the skin tissue using a low electric current. Remember you skin will be numb therefore you should not have any discomfort
• Once the incision site or wound has been cauterised and cleansed, no further dressing is required. You can then replace your appliance over the stoma. You should change your appliance preferably in the next 24 hours to check if the wound is healing and there isn't any obvious sign of infection

Benefits and risks

The benefits to this treatment are that the granuloma is treated directly with an immediate result. You are pain free as the painful area treated is removed. The hydrocolloid stoma flange helps heal the treated area. Further treatment can also be repeated as required.

Overall, this treatment provides good patient satisfaction, as appliances are adhering to the skin, preventing leakages and reducing patient distress.

There are little known risks to this treatment, infection at the site treated is very rare and bleeding afterwards is also rare. Bowel perforation is theoretically possible, but not known therefore, unlikely.

If you have any questions, please contact the Stoma Care Department on 0161 206 4204.

Is there anything I should tell doctor/stoma nurse before treatment?

You should tell doctor/stoma nurse if you have any medical conditions, especially:

• If you are taking any form of anti-coagulation medicines such as: Warfarin, Aspirin or injections used to thin your blood
• If you are allergic or reacted badly in the past to local anaesthetics
• If you suffer from any allergies

Can I refuse to have the treatment?

You always have the right to refuse treatment. Any concerns you may have should be discussed with your stoma care nurse who will be happy to help you understand your best option of care.

This procedure usually takes 15-20 minutes. You can go home and resume normal activity the same day.

Questions or further information?

If you have any questions or concerns, please do not hesitate to contact the Stoma Care Department on 0161 206 4204 (Monday to Friday, 7.00am to 5.30pm) or email stomacare@nca.nhs.uk.