title: A case of pressure ulceration and associated haemorrhage in a patient using a faecal management system.
abstract: Diarrhoea is a difficult patient problem to manage in the intensive care setting, causing odour, discomfort and embarrassment for the patient and potential for loss of skin integrity and cross contamination. Caring for these patients is resource-intensive. A recently developed product for the management of faecal incontinence is the Flexi-Seal Faecal Management System (FMS(©)). Whilst this product is usually effective for managing diarrhoea, there are uncommon but serious complications associated with its use. Rectal bleeding attributed to pressure ulceration of the rectal mucosa can be severe, especially in conjunction with the use of anticoagulation. We report a case of severe rectal bleeding requiring surgical intervention and administration of large amounts of blood products, caused by pressure ulceration as a result of the use of a Flexi-Seal FMS(©). The case report is followed by a review of the literature. Similar complications have been described by others. Although, based on the number of reported complications, the incidence of serious complications appears to be low, a publication bias cannot be ruled out. Knowledge of the complications associated with the device is important for evaluating the appropriateness of insertion and for ensuring the safe and effective on going care of patients using Flexi-Seal FMS(©).
authors.affiliation: ICU, Waikato Hospital, Hamilton, New Zealand. Mark.Reynolds@waikatodhb.health.nz
authors.forename: Mark G
authors.initials: MG
authors.lastname: Reynolds
authors.forename: Frank
authors.initials: F
authors.lastname: van Haren
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016638:Critical Illness; D004867:Equipment Design; D005242:Fecal Incontinence / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology*; D012002:Rectal Diseases / Q000209:etiology*; D012007:Rectum / Q000473:pathology; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin