Case

Jane was admitted 3 months after her emergency surgery for reversal of the Hartmann's operation.

Jane had spent the previous 3 months at home trying to adjust to life with a colostomy. She had managed to some extent but had not ventured out of her house very often. Jane had put her life on hold, waiting for a date for her reversal operation. During Jane's last outpatient appointment the colorectal surgeon examined the wound, which had taken a further 4 weeks to heal, after Jane's discharge from hospital, and although she had a wider scar on her abdomen the surgeon was pleased with the result. The consultant explained to Jane that he would have to reopen the scar in order to perform the reversal operation. The consultant went on to discuss the operation and its risks and outcomes with Jane and her husband. He explained that the intention was to join the colon back together and close the colostomy. He did warn Jane that this could prove impossible, in which case she would be left with a permanent colostomy, but he hoped that this would not be the case. Jane said that she felt it would be worth the risk because she could not live with a colostomy for the rest of her life. The SCN, who was also present, asked Jane what would happen if the colostomy could not be reversed. Jane said that she felt unable to think about the possibility of life with a colostomy but undoubtedly she would cross that bridge if she had to.

Jane was admitted to the colorectal ward for her surgery. This time she was able to walk on to the ward and be introduced to the other patients and nursing staff in the four-bedded ward. Jane had all her routine observations taken and was left to settle in. At 06:00 hours Jane started to take the prescribed bowel preparation regimen to cleanse her bowel. Jane had not had bowel preparation the previous time because of her emergency status. The nurse explained the rationale for taking a bowel preparation and its outcome. Jane would also be having a clear fluid diet. The second sachet of bowel preparation would be given at lunchtime, followed later in the afternoon by a rectal phosphate enema to empty the rectum of any debris. The nurse looking after Jane considered the outcome of the bowel preparation and enema successful.

The day of surgery dawned and Jane was taken to theatre for her reversal of the Hartmann's procedure, which was completed without any problems.

Jane was returned to the ward from the recovery suite and her observations noted. Jane had an intravenous fusion in progress and a urinary catheter and two dressings on her abdomen, one covering the main laparotomy incision and the other over the now sutured colostomy site. When Jane woke up her first action was to feel her abdomen to check if she still had a colostomy bag and she was pleased to find only a dressing.

Over the next couple of days Jane had an uneventful recovery and was soon to be found walking around the ward. Jane was like a different person, confident, happy and very talkative. The SCN found Jane talking to another patient who had a colostomy; Jane was telling her that it was not too bad once you got used to it and no it did not cause any problems; they even swapped phone numbers so that they could keep in touch. The SCN thanked Jane for her input with the other patient and asked Jane why she had had the change of mind. Jane said that looking back it had not been so bad and she was so grateful not to have the stoma any more that she could think like this now. The SCN was not surprised at Jane's change of attitude; she had seen it before. Jane's progress continued well and when her bowels opened Jane began to look forward to going home.

The SCN reminded Jane that her bowel habit may not return to its preoperative state. The nurse also gave Jane her discharge leaflet about the dos and don'ts after surgery.

Jane returned to the outpatient department 6 weeks later. She was very well; her bowels were opened up to three times a day and she was planning a holiday, because she felt able to consider this now. Jane thanked all the staff and offered to talk to any other patients if the SCN thought that it would help.

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