The patient was admitted to the hospital with “blood in the stool for more than 6 months, aggravated for 3 months”. Patient Cai**, female, 49 years old, was admitted to the hospital with “blood in the stool for more than 6 months, aggravated for 3 months”. Current medical history: the patient 6 months ago no obvious cause appeared in the stool mixed with fresh blood, dark brown stool, 3-4 days once, no abdominal pain, nausea and vomiting, reflux heartburn and other discomfort, 3 months ago the patient increased the amount of blood in the stool than before, the process of defecation occasionally first pulling blood and then poop phenomenon, 1 time / day, the blood is bright red or dark brown, with a feeling of swelling at the anus in, the local hospital, diagnosed as “He was diagnosed as “hemorrhoid” and given medication (corresponding drug name unknown) after the symptoms of blood in the stool improved, but recurred after stopping the medication, and underwent a colonoscopy at the local hospital showing rectal Ca? “The patient was admitted to our department. Since the onset of the disease, the patient has been mentally and appetite, poor sleep, normal physical strength, stool as described above, normal urine, and weight loss of about 5 kg in the past 3 months. Past history: respiratory symptoms: chronic bronchitis for 30 years, circulatory symptoms: none, digestive symptoms: none, urinary symptoms: none, hematologic symptoms: none, endocrine metabolic symptoms: none, neuropsychiatric symptoms: none, reproductive symptoms: none, motor symptoms: none. None, motor system symptoms: None, history of infectious diseases: denied history of hepatitis, tuberculosis or other infectious diseases, history of vaccination: vaccination according to national plan, other: no special, history of allergy: denied history of drug and food allergy, history of trauma: denied history of trauma, history of surgery: denied history of surgery Check-up: T: 36.8℃, P: 78 times/min, R: 20 times/min, BP: 133/90mmHg. Clear consciousness, cooperative physical examination, normal facial appearance, lymph nodes: no enlargement of superficial lymph nodes throughout the body. Heart rate {heart rate} times/min, rhythmical, normal heart sounds, no murmur was heard in each valve area. Visual examination: no abnormality in the apical oscillation of the lungs, no abnormal elevation or depression, auscultation: clear respiratory sounds in both lungs, no dry and wet bow targeting sigma-rhythmic woven 8 co-clients, pressure pain and rebound pain: no pressure pain in the whole abdomen, slight rebound pain in the right lower abdomen, mass: no mass was palpated in the abdomen, liver: liver was not palpated under the ribs, spleen: spleen was not palpated under the ribs. No edema in both lower limbs. Physiological reflexes were present and pathological reflexes were not elicited. Specialized conditions:No yellow staining of skin and sclera, no bleeding spots, purpura and petechiae in the generalized skin mucosa, no palpable enlargement of superficial lymph nodes, no pressure pain in the sternum, no significant abnormalities in cardiopulmonary auscultation, flat and soft abdomen, no pressure pain, slight rebound pain in the right lower abdomen, no subcostal palpation of the liver and spleen, mild edema in both lower limbs. Auxiliary examination: 2014-09-04 Wuhan Union Hospital e-colonoscopy: rectal Ca, internal hemorrhoids Preliminary diagnosis: rectal cancer? Internal hemorrhoid The patient underwent laparoscopic radical rectal cancer surgery in us on 2014-9-16 and found pathology: an ulcerated neoplasm of about 125px*100px in size was seen 100px from the anus intraoperatively, the mucosa around the lesion was elevated, the center was necrotic and bleeding, the texture was tough and easy to bleed when touched, the lesion invaded about 1/2 circle of the intestinal lumen, the plasma membrane layer of the intestinal wall was intact, several lymph nodes were seen around the rectum and hyperplasia. The anterior wall of the rectum was densely adherent to the uterus, the liver did not have obvious nodules, there was no obvious ascites in the abdominal cavity, no obvious metastatic lesions, and no obvious enlarged lymph nodes were seen in the mesentery. Postoperative pathology: (rectum) moderately differentiated adenocarcinoma infiltrated the whole intestinal wall and extra-mural adipose tissue, mesenteric lymph nodes (6/9) and lymph nodes (3/6) sending ① (root of the inferior mesenteric artery) metastasis of cancer (2 other metastatic nodes were seen), no cancer involvement was seen on both sides of the cut edge section of the surgical specimen. The patient was discharged from the hospital on 2014-10-1. Discharge status: the patient’s general condition was acceptable, there was no yellow staining of the skin and sclera, no bleeding spots, purpura and petechiae in the general skin mucosa, no palpable enlargement of superficial lymph nodes, no pressure pain in the sternum, no significant abnormalities in cardiopulmonary auscultation, flat and soft abdomen, no pressure pain, slight rebound pain in the right lower abdomen, no palpable liver and spleen under the ribs, and mild edema in both lower limbs. Discharge diagnosis: (rectal) medium differentiated adenocarcinoma Patient’s message: “Dear Professor Xiao and Dr. Liu Xin, hello! I am very grateful to Prof. Xiao, Dr. Liu Xin and the nurses for their care and hard work for my recovery. I am grateful again, thank you!” The patient’s postoperative stoma was a sigmoid colostomy, which was relatively formed after the intestinal contents were absorbed through the small intestine, ileocecal region and the whole colon. Usually the bag is changed once a week, and don’t forget to dilate the fistula regularly to prevent strictures. Protect the skin around the stoma: at the beginning of the opening of the stoma, the stool is thin and irritating to the skin, which can easily cause skin erosion. After each bowel movement, you should immediately wash the skin around the stoma with warm water and apply stoma powder or skin protection film to protect it. Replace the stoma bag: (Preparation: stoma bag, stoma powder, skin protection film, anti-leakage cream, transparent paste, scissors, towels, warm water, paper towels, cotton swabs, etc.) Operation method: 1, the stoma bag chassis cut into the appropriate size, 1-2mm larger than the diameter of the stoma, cut too small, the stoma pressure, affecting blood circulation; cut too large, excrement contact with the skin, easy to corrode the skin caused by ulceration. At the same time, the size of the cutout is changed with the size of the stoma. 2. Gently wipe away the secretions from the stoma and surrounding skin with a tissue, disinfect the stoma mucosa with a saline swab, gently scrub the surrounding skin with warm water, and air dry. 3.Apply stoma powder around the stoma, taking care not to overdo it and not to oversize the area, otherwise it will affect the adhesion firmness of the chassis. Apply anti-leakage cream around the stoma with a width of no more than 25px. The anti-leakage cream is sticky and can be applied evenly by pressing with a small amount of water with the plastic stick that comes with it. Apply skin protection film evenly on the skin around the stoma and leave to dry for 5 seconds. 4, the stoma chassis paper torn off, the cutout aligned with the stoma, set into the stoma, with the palm of your hand moderate force lightly press the stoma bag chassis, so that it is flat, uniform adhesion solid, available palm cover 5 minutes in winter, can make the chassis of the adhesive softening adhesion more firmly. Early post-operative patients lying down, the stoma bag should be horizontal paste; out of bed activities, the stoma bag vertical paste. 5, the skin around the stoma should not be cleaned or disinfected with alkaline soap, alcohol, iodine, iodophor and other liquids, because of its strong stimulation, easy to cause dry, damaged skin. 6, the stoma bag excrement 1/3 full, to timely discharge, the lower end of the stoma bag can be properly cleaned to maintain hygiene. 7, when uncovering the stoma bag, one hand press the skin slightly above the stoma bag, the other hand from the top down gently uncover the stoma bag, not too fast, too much force to prevent skin damage. Usually the third month after surgery, eating habits and the number of times has been fixed, you can use the kind of non-adhesive fixed stoma pockets during the day, online or drugstore sales, you can wrap the waist and abdomen fixed at the stoma, the bag can be disassembled and fixed stoma base twisted to wear the removal, relatively convenient, easy to change and wash. From the fourth month onward, you can wear the bag during the day without a fistula bag, find the time to fix the big hand, wash it regularly, and usually go out with an absorbent paper or plastic wrap at the stoma. At night, you need to wear a fistula bag, which usually drains more. You can also go to the fistula clinic on the fifth floor of the outpatient building at the main clinic of Concordia every Wednesday and Friday for regular review and examination.