B0316 - Bleeding Complications From Fecal Management Systems in the COVID Era: A Single Center Experience

Mark S. McFarland, MD, MSc¹, Kenneth W. Hung, MD, MS², Darrick K. Li, MD, PhD², Michelle L. Hughes, MD^2
1Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT; ²Yale University School of Medicine, New Haven, CT

Introduction: Fecal Management Systems (FMS) have become common practice in hospitalized patients with severe diarrhea, or pressure wounds. These devices allow diversion of stool away from the body in an enclosed system. Contraindications to FMS placement include hemorrhoids, anal strictures, rectal mucosal impairment and device use for greater than 29 days. Although FMS are generally safe and effective, severe rectal bleeding has been reported in a small number of studies and case reports though characteristics not well-defined. The goal of this study was to investigate patient characteristics with FMS use and subsequent development of severe bleeding complications.

Methods: We reviewed endoscopy reports for rectal ulcerations and identified 16 patients who developed severe rectal bleeding from FMS at a large medical center from August 1, 2019 to August 1, 2021. Severe rectal bleeding was defined as requirement of blood transfusion, endoscopy or embolization. Demographics, medications, and hospitalization characteristics were extracted from the medical record. Mean, standard deviation, and percentages were calculated for variables of interest.

Results: Patients who bled with FMS had prolonged hospitalizations (mean 67.4 days), and 50% (8/16) died during hospitalization (Table 1). 43.8% (7/16) had COVID-19 infection, and 75% (12/16) were cared for in intensive care units. 18.8% (3/16) were on antiplatelets, and 50% were on anticoagulation. 93.8% (15/16) of patients who bled with FMS required blood transfusion, receiving 6.1±6.3 units of blood during their hospital admission. 81.3% (13/16) required endoscopy, 12.5% (2/16) required second endoscopy for hemostasis, and 6.3% (1/16) required embolization by Interventional Radiology. Of note, 18.8% (3/16) patients had hemorrhoids, 18.8% (3/16) had FMS for longer than 29 days, and only 37.5% (6/16) had an order for a rectal tube placed. No severe bleeding complications occurred in the 10 months prior to COVID-19 pandemic.

Discussion: FMS has clinical utility but carries risks of severe bleeding complications. It remains unclear how COVID-19 impacted rates of these complications as baseline utilization could not be assessed in our center. Careful attention to hemorrhoids, FMS placement > 29 days, and other relative contraindications like coagulopathy is important to improve patient safety. Interventions should be developed to ensure safe, appropriate FMS placement and timely removal of FMS to avoid adverse events.




Disclosures:


Mark S. McFarland, MD, MSc¹, Kenneth W. Hung, MD, MS², Darrick K. Li, MD, PhD², Michelle L. Hughes, MD². B0316 - Bleeding Complications From Fecal Management Systems in the COVID Era: A Single Center Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.