Colostomy and ileostomy closures - a surgical ordeal for my wife
Surgical interventions sometimes become essential to correct certain medical conditions. This gives relief to the patient and most of the times he or she improves and comes back to his normal life. Unfortunately in some cases complications take place and then further medical actions become necessary to save the life of the patient. This case history is pertaining to my wife and is a story consisting of a series of operations and in fact during that ordeal I learned a great bit of things related to this medical condition. Susequenly, I thought to bring these experiences in black and white for the readers interested in medical case histories and may be some colostomy patients may also get some valuable information from this narration.
The need for first surgery
My wife was having a problem of backpain and irregular menstruation and on medical examination we were told that some small tumour was building up in the uterus and was responsible for these symtoms. The doctor told that if it increases in the size than it may require surgical procedure to remove it. This was in the year 2003 and soon we forget about this and she was living with that tumour whatever size it was. Time was flowing like that and in March, 2004 when we were staying in a guest house in Delhi for a short visit she suddenly started heavy bleeding and later we came to know that actually the tumour was well enlarged and had bursted and started to bleed on that day. It was really an emergency situation and I took her to the nearest hospital and they put him on saline, glucose and then some routine test and finally started to give her blood. It took some time for the bleeding to stop and once her condition became stable they advised us to go for removal of the uterus (hysterectomy). As there was no other alternative we simply nodded for it.
The first surgery - hysterectomy
Just a few days after the patient came to a stable condition by continuously giving blood and other liquids intaravenously, we were told about the hysterectomy operation. The operation was carried out in March, 2004. During the operation the surgeon removed the uterus and associated parts with much care. It was an open surgery and the lower abdomen was slit open to make place for working of the surgeon and removal of the uterus as well as the parts of the burst tumour. Anyway, operation was completed and patient was first kept in ICU and then shifted to the room for complete recovery.
Post hysterectomy coplications
Just after 2-3 days partient started complaining of fever and also found that stool was coming out from the vagina also. It was a fearful thing to see that and immediately the surgeon was called. After some observations and tests the surgeon told that there is a cut in the rectum through which the stool is leaking to the vagina and in medical terms it is known as recto-vaginal fistula. He also told that this was a serious situation and only way to combat it was going for a colostomy surgery.
The surgeon also told that there were two options after the colostomy operation. First is that the patient may opt to live rest of his life with colostomy and second is after some time when the fistula is healed go for closure of the colostomy to become normal as earlier.
The colostomy operation
The patient was referred to another surgeon in the same hospital who was a colostomy expert. He came and explained us about it. The cut in the walls of the rectum is opening to vagina and until this cut is sutured and healed nothing can pass through it. So it means this part has to be repaired and kept for healing for quite some time and during that long interval the patient has to be provided an outlet for the stool and that is where colostomy operation comes in picture.
Human alimentary canal starts from the throat and then have food pipe, stomach, small intestine, large intestine and then rectum from where the stool is passed out. The large intestine is also known as Colon and it has three distinguishable parts known as ascending column which rises from the lower end of small intestine, transverse column and descending column which is connected to rectum.
The descending column is generally the place where colostomy operation is carried out in such cases of recto-vaginal fistula complication. The basic procedure for the operation is to cut a big slit on the left side of abdomen and to pullout the descending pipe of the Colon outside and cut it and make an artificial opening at that place. At the same time the lower abdomen is also slit opened to join the lower part of descending column which is hanging free now to some part in the abdomen wall normally at the navel level so that it gets blood supply and remains alive for long time when the patient returns back to the hospital for closure of colostomy and joining these two parts back to make the patient normal.
Anyway, the colostomy was done by the surgeon just after 12 days of hysterectomy and after healing of the colostomy wound, the patient was relieved from the hospital with an instruction of coming back to the hospital after 4-6 months for closure of the colostomy. The colostomy wound as seen on the abdomen skin is generally around 1-1/2 inch in size. A nurse explained to us how to fix a colostomy bag on the skin of the patient around the colostomy so that the stool does not spill outside and is collected only in the bag. The bag was supposed to be changed two times in a day just after the motions. The bag was made of synthetic material and on the top of it there was a self adhesive round plastic disc which was to be fixed on the skin around the colostomy. The disc had a big hole in the centre to accommodate the colostomy wound.
Colostomy/ ileostomy bags are available in Amazon
These bags are good to handle and easy to use and can be drained intermittently.
I learned the fixing and changing of colostomy bags and started to do it regularly. This was a tedious thing to do but I had to do it as colostomy nurses were not available so easily and moreover it was a costly proposition to hire them full time.
Another problem was that the self adhesive disc created rashes on the skin and we had to use certain ointments and medicine to cure it. In all, maintaining colostomy was a very difficult task sometines testing the limits of ones patience.
To give the skin of the surrounding place a break from the self adhesive disc I innovated simple cotton bags fastened to the skin with medical tapes. That gave some relief but these cotton bags were to be replaced more frequently due to hygenic reasons.
First colostomy closure operation failed
Time passed like that managing life with colostomy and after about 1 year we decided to cosult the doctor for closing it and keeping the colon back to its original position so that the patient can live a normal life. This time we wanted to go to a more reputed surgeon so we consulted a doctor in one of the good hospitals in Mumbai who asked us to get admission for closing it. The recto-vaginal fistula was found to be perfectly healed and there was no hole or slit in the rectum wall so doctor fixed a date for operation. In March, 2005, the colostomy closure operation was done and took a few hours and apparently everything appeared normal. After 2-3 days motion did not start and patient started to have discomfort in the abdomen area. Endoscopy was done and it was found that probably the colon joint was not working and the to and fro motion of alimentary canal was not taking place in the colon around the joint and there was no flow of food or stool materials through it. It was again a serious condition and in such cases the only option is to go for another ooeration by sacrificing a small length of earlier ends of the cut colon and join them again. The surgeon told that as the lower part of colon up to rectum was temporary connected to abdomen interior at the navel level for keeping it alive for long but it might happen that due to limited blood supply to it, same might not be as vibrant and another attempt after cutting small lengths at the ends and joining them again could be made but there was a hitch that after joining it has to be healed which will take time and meanwhile the patient has to go for ileostomy which is actually another operation of bringing smaller intestine out of the abdomen at some suitable point so that stool can come from it till the colon joint is healed.
This was really another blow to the patient and then there was no go except going for an operation called ileostomy.
Second joining of colon and Ileostomy operation
So the colon was again joined as planned and ileostomy was grafted on the left side of the patients abdomen. After healing of ileostomy wound the patient was discharged with an instruction to come back after 3-4 months for closure of ileostomy. It was hoped that by that time the colon joint would also be perfectly healed.
Ileostomy was to be managed in the same way as we were earlier managing the colostomy. But this was more difficult as partially digested food was coming out of the ileostomy wound and creating more rashes and irritation on skin as compared to the colostomy. Anyhow, using the bags and cotton somehow we managed this and waited for a few months for healing of the colon joint.
Closure of ileostomy
In September, 2005 the patient was again admitted in the same hospital where the surgeon had done ileostomy and this time after the ileostomy closure operation, within a few days the alimentary canal started to work properly which showed that earlier colostomy closure and colon joint was also working. After a few days the patient was discharged from the hospital.
Due to the formation of a recto-vaginal fistula subsequent to hysterectomy operation, my wife had to undergo a series of operations which had been a traumatic experience creating continuous stress and anxiety in her. 14 years have passed since that last operation and she is keeping a normal health. It was a difficult time but God gave us courage and strength to face that.