Emergency Surgery

Patients who have diverticulitis may suddenly find that they have an exacerbation of the disease and an emergency admission to hospital is needed. After initial investigations are done the patient will be prepared for an emergency operation. It is often not the reason for the emergency

M abdominals

Pericardium

M abdominals

Pericardium

Small or large intestine

Figure 8.1 Ostomy: side view. (Courtesy of Dansac Ltd.)

Small or large intestine surgery that is considered, but the implications of the sudden event that affect the eventual rehabilitation of the ostomate. Abrams (1984) has suggested that there is never too much time to prepare the patient for the outcome of surgery resulting in a possible stoma whether permanent or temporary:

In my experience the worst results, psychologically, have been with patients who have either received no preparation or were too sick to be prepared or who were given inaccurate or dishonest information.

A significant proportion of ostomates undergo emergency surgery and Devlin (1984) suggests that about 30% of patients with a stoma fall into this category and that nursing and medical attitudes are crucial to the ultimate long-term effect of recovery for this group of patients.

When a patient undergoes emergency bowel surgery for diverticulitis, there is little or no time for preoperative preparation, let alone siting of the stoma. Many patients are admitted to A&E at night or in the early hours of the morning, and proceed to theatre from the department, going to a ward only on return from theatre. Many patients therefore wake to find that they have a stoma without either understanding or even knowing beforehand of its possibility. Morrison (1978) suggests subsequently that it is not surprising that many patients may feel that they have been assaulted or unable to accept a stoma to which they never agreed in the first place. It appears that the obstacles to rehabilitation and adaptation are greater for the patient who has emergency stoma surgery than for the patient who has elective surgery.

In interpreting the research about whether patients having an emergency stoma with little or no preoperative preparation fare badly as opposed to the elective patient who receives adequate counselling and information, it seems that those patients who know most about their operations have the slowest recovery. In the two studies by Cohen (1975) and Cohen and Lazarus (1973), which investigate the relationship between the recovery from surgery and the avoidance or vigilance towards seeking information about the condition and surgery, it has been suggested that vigilant 'copers' seek to master the world by seeking information, although this style is maladaptive in the postoperative period when patients are relatively powerless. In the current age when the internet is so readily available, many patients and relatives come armed with files of information about their disease and operative procedures before or after surgery, questioning the information that they are receiving from the nurses and doctors.

In Wade's research (1989) her second interviews with stoma patients revealed that, of her cohort, 26.9% of the women and 19.1% of the men said that they were unable to accept their stoma, with extreme negativity demonstrated by 6.7% of the patients. Acceptance of the stoma was higher among those with a permanent stoma, 81.5%, than those with temporary colostomies. One patient states:

They never told me beforehand that I was going to have a stoma. The thing that worries me is the fact that I feel a burden to my wife. If I did not have this nagging pain in my legs and back - if I did not have that I could go out and walk about freely - I think you probably know the answer would be ok, 100%.

For those patients still with a temporary stoma 1 year after surgery, 27% of women and 19% of men still felt unable to accept their stoma.

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