This topic is about a person who was scheduled for a stoma revision surgery to address nodules at the stoma site. However, the surgery was canceled when a new ulcer appeared near the stoma, raising concerns about its connection to Crohn’s disease. Here are some insights and advice shared in the discussion:

1. The person had been taking photos of their stoma at each barrier change to show the surgeon, which helped in identifying the new ulcer.

2. The surgeon suspected the ulcer might be an extra-intestinal manifestation of Crohn’s disease rather than a pressure sore, leading to the cancellation of the surgery to avoid worsening the condition.

3. The person had recently restarted Crohn’s medication, including prednisone and Mercaptopurine, after a delay due to pharmacy issues.

4. They had been using a Hollister convex barrier to manage leakage around the nodules but were concerned that the pressure from the barrier might have contributed to the ulcer.

5. They sought practical tips for caring for an ulcer located beneath the wafer/barrier.

6. Four days after discovering the ulcer, its size remained unchanged, though some mucus was present. There was no pain from the ulcer or nodules, just the usual Crohn’s-related abdominal discomfort.

7. They used pieces of a Hollister Adapt barrier ring over the ulcer and planned to reassess at the next change.

8. The consistency of their output improved after restarting the medication, with no more liquid output.

9. They asked for advice on whether to fit the wafer around or over a fistula/ulcer and whether such lesions are typically painful.

Advice and insights from the discussion included:

- It’s important to identify the lesion accurately. A biopsy and a dermatologist’s opinion can help determine if it’s related to Crohn’s, a fistula, a pyoderma gangrenosum ulcer, or granulation tissue.

- If pyoderma gangrenosum is confirmed, cortisone (steroid) injections directly into the ulcer may be beneficial.

- Granulation tissue on the edges of the ulcer can stay wet and prevent adhesion. Silver-nitrate sticks can be used to cauterize these edges and improve wafer adherence.

- When fitting the appliance, use a convex wafer cut to include both the stoma and the ulcer in one opening, even if it’s an unusual shape. Be prepared for more frequent changes as the ulcer edges may not adhere well.

- Taking photos at each change provides a useful timeline for healthcare providers.

- It’s important to give systemic medications time to work. Once the ulcer settles, the possibility of stoma revision can be reconsidered.