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granulation tissue at the G tube stoma

corleone's picture
corleone
Posts: 156
Joined: Jul 2012

The stoma where the G tube is inserted started to develop granulation tissue a while ago, but this issue became significant just a few days ago. The tissue is forming now at a higher pace, it’s about the size of a pea and it’s very friable (bleeds easily). The reason for this is the increased friction, as the tube moves in and out approximately 1 inch. I could make the dressing more tightly, so that the tube doesn’t move so much, but I am not sure if that’s a good idea. In the morning, when I am hungry, the stomach pulls the tube in (the dressing “allows” an approximately 1 inch freedom of movement, but the stomach movement would pull in much more than that if not for the dressing). After I eat the tube is slowly “released” out. Sometimes I also experience a little bit of pain, just before the tube starts to move in (initially the tube is kept in place by dried detritus, and until this is broken apart and tube starts to move, it’s painful).
I would like to hear from veterans how they are dealing with this. It’s not necessarily the granulation tissue that bothers me (I can find tips on how to treat it on the internet); it’s just that I’d like to hear how you are dealing with the tube movement. Mine is the gastric type, kept inside the stomach by a hemisphere shaped plastic (it’s not a balloon). It doesn’t have any device at the exterior to keep it in place, the tube just exits from the stoma. I wonder how much freedom of movement (in and out) is ideal. I reckon that the less movement, the less friction and less granulation tissue. On the other hand, not allowing the tube, (I guess) might create other problems.
The best solution would be to have it removed, but I still have the third round of chemo (carbo and 5FU) next week, and the med oncologist didn’t agree to remove it before I finish the treatment. So I have to cope with it for at least another 3-4 weeks (time needed for the side effects to diminish).

phrannie51's picture
phrannie51
Posts: 3691
Joined: Mar 2012

mine hurt, tho. I kept it soft with 3 in one ointment...it also greases up the tube a little making for less friction. My Onc is who told me to use it. I put it on every morning and every evening.

p

longtermsurvivor's picture
longtermsurvivor
Posts: 1792
Joined: Mar 2010

but the granulation tissue is, after all, the majority of the problem. It has a rich nerve supply in addition to a rich vascular supply. The treatment of choice is silver nitrate (AgNO3) which comes on the end of small sticks, looking like long handled matches. You simply swab it on. It will turn the tissue black as night and will cause remarkable involution. You can repeat this process every few days as needed. This will need done anyway, as pulling your tube will not magically make the tissue go away. Your health care provider can dothis for you, or maybe if you talk nicely, he/she will just give you a bunch of these.

best

Pat

ratface's picture
ratface
Posts: 1238
Joined: Aug 2009

Mine was kept in place on the inside by the hard plastic mushroom head but it also had a collar and smaller head on the outside. Are you absolutely sure there is nothing on the outside keeping it from falling in? They must have changed design then because there was a small bumper on the outside that you could slide up or down on the tube to adjust travel in either direction? perhaps they have built a better mouse trap?

corleone's picture
corleone
Posts: 156
Joined: Jul 2012

@ratface: nothing on the outside. It’s just the tube, coming off the stoma. It’s free to go in as much as “it” likes, if it’s not kept in place by the dressing.

ratface's picture
ratface
Posts: 1238
Joined: Aug 2009

I can see where it might have changed in design as I was always moving that outside bumper around to loosen up the crud and get it off my skin but it may have created new problems. Any chance they forgot to put it on?

Ingrid K's picture
Ingrid K
Posts: 811
Joined: Mar 2011

If I had to guess, I would agree with Rat*rick* above. I think there is a bumper type of piece missing on the outside...there has to be something to keep the entire tube from being sucked into your stomach. OUCH, that does sound painful. I would certainly call the doctor about it or visit the ER.

corleone's picture
corleone
Posts: 156
Joined: Jul 2012

... while I was hospitalized for my last (hopefully) adjuvant chemo therapy. They didn’t seem worried, and they confirmed that this is the actual “configuration” of the tube, there is no contraption to limit the movement inside, except, of course the dressing that keeps it stuck to the abdomen skin. It seems that it’s a matter of personal choice how much of the free tube you leave between the exit from stoma and the dressing. I would definitely allow the tube to move inside and out for a short distance, like up to 1 inch, it’s just that whenever it goes inside, it also brings (inside the abdomen, including peritoneal cavity) the beasts (microbes) that live on the skin and the surface of the tube. My local defense (immune) system was not overwhelmed until now, it’s just that carboplatin is neutropenic, and you never know. Well, I will get rid of it in a couple of weeks or so, hopefully there will be no infection in the meantime. The granulation tissue will continue to be a nuisance, but it can be treated.
Again, thank you all for your suggestions and concerns.

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