To the Editor:

Carlsson E, Gylin M, Nilsson L, Svensson K, Alverslid I, Persson E. Positive and negative aspects of colostomy irrigation: a patient and WOC nurse perspective. JWOCN. 2010;37:511-516.

Within the "Conclusion" paragraph on page 515 is found the sentence that "women undergoing surgery for rectal cancer had significantly higher concerns than men preoperatively for producing unpleasant odors...." Ironically, this expressed concern is rooted in fact as noted by a pivotal study in 1998 by Levitt and colleagues as I note below. Perhaps it would have been helpful for Carlsson and colleagues to have noted and referenced the physiological differences in flatus characteristics between the genders and applied this distinction to the role and benefit of colostomy irrigation as a method of coping with the greater threat of odor offense found in women. Better still, it might have been more helpful to have directly informed women of this additional odor risk.

Suarez FL, Springfield J, Levitt MD. Identification of gases responsible for the odour of human flatus and evaluation of a device purported to reduce this odour. Gut. 1998;43:100-104 (page 101). See Table 1 which compares the flatus of men and women. The flatus of women had a significantly higher concentration of hydrogen sulphide (P < .01) and a greater odor intensity (P < .02) than did that of men. However, men tended to pass higher volumes of gas than did women (P = .055). As a result, the volume of sulphur gases in each passage did not differ between men and women.

Ratliff CR. Early peristomal skin complications reported by WOC nurses. JWOCN. 2010;37:505-510.

Reference is made throughout the article to one patient having an allergic reaction noted on the peristomal skin. Throughout the long history of WOC nursing practice, I have noted this reference without any supportive testimony to a type IV delayed hypersensitivity reaction being identified. Too often, the characterization of an irritant contact dermatitis (ICD) is applied to an allergic contact dermatitis (ACD). Because ICD and ACD cannot be differentiated with certainty on clinical grounds, patch testing remains an essential tool in the diagnostic process. I am not certain that many WOC nurse colleagues are skilled enough, or have the time to employ and accurately interpret patch tests in order to differentiate ICD from ACD. Additionally, there is not one dermatology-specific journal reference included in the list of references from which the reader can benefit, especially when the topic is skin, peristomal, or otherwise. I find that this link http://www.wsiat.on.ca/english/mlo/allergic.htm differentiates characteristics of ACD versus ICD.

Mike D'Orazio, ET