John, aged 37, was admitted from his place of work to the hospital A&E department at 10am complaining of severe abdominal pain and nausea, tachycardia and sweating. He was examined by a doctor from the colorectal team who decided that John had an acute appendicitis and would be prepared for theatre immediately.
At operation an appendix incision was made but the surgeon quickly noted that the appendix was normal and proceeded to a midline laparotomy wound. In the descending sigmoid colon they found a perforated bowel significant of diverticulitis. The bowel was removed in a Hartmann's procedure resulting in a colostomy.
After surgery John and his wife were told the diagnosis and the colostomy was explained to them. They were told that the colostomy was reversible in a few months after John had recovered. John found this news of his colostomy very difficult to take in. He was a subcontracted, self-employed lorry driver and had little day-to-day access to a toilet with private facilities to cope with appliance changing.
John's psychological recovery in hospital was stormy because he could not accept that he had a stoma and would talk about his stoma as if it was not part of his body. He would walk around the ward with his pyjama top wide open and his stoma bag showing which could become offensive to other patients and relatives. When asked if he could keep his appliance covered while up and about he said that he always walked about with his shirt off and he could not see what the problem was as there was nothing unusual about his abdomen. The stoma care nurse was asked to try to help him by empowering him towards self-care, but John was very reluctant. Even with his wife's encouragement John said that his wife would see to the bag'.
Two weeks after his discharge, John would telephone every day to try to rearrange his postoperative follow-up and to be put straight on the list for reversal. He was seen in clinic at 8 weeks after surgery and was told he would be put on the waiting list for reversal. Two weeks later John opted for private care and had a reversal the following week, discharging himself from hospital after 5 days. So far John had not attended for his two surgical follow-up visits and therefore his care has been put back to his GP.
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