Complications

You may have seen my post on my Facebook page saying that I had developed post op complications. Here's what's happened. Apologies in advance for the biology lesson but to understand the complications it will help you to know what took place during this and previous surgeries.

When I had my large bowel removed in 2009 I was left with an end ileostomy. This is a semi/permanent Stoma that may be reversed if the rectum is intact, as was the case with me. (These pictures show where the large bowel would be if it was still in place. The thin tube is the small bowel.)

The operation that I had in July last year was to form a pouch internally and left me with a loop ileostomy which is a temporary Stoma. The pouch is best described as an internal 'holding area' for your poo. Almost like a Stoma bag on the inside, made out of your insides!

Most people reading this would hold their poo in their large bowel/rectum prior to going to the toilet. When you don't have a large bowel that's obviously not an option so a pouch is made out of your small bowel. There's lots of different designs (with the name typically describing the shape of the newly rearranged small bowel) but my particular one is a 'J pouch'. 

Unfortunately not every patient that has a Stoma is able to have it reversed. Considerations include the function of the rectal sphincters, how much small bowel you have and your general health other than the bowel issues. 

In my most recent operation the loop ileostomy was closed and the bit of bowel that made my stoma and that stuck out of my tummy was put back inside me. And this is where the complication arose. 

In the early hours of Monday morning I woke up needing to go to the toilet and empty my pouch (aka do a poo) once or twice an hour. Every hour. As well as being completely exhausted from this my bottom was getting very sore and I was in a lot of pain. 

By about 8am I was in tears as the pain was so bad. The sister came and gave me some morphine but that didn't really help at all so she called the doctor. 

Mr Aziz (one of the surgical consultants) came and examined me and I was in a considerable amount of pain. The pain was located mainly around the old Stoma /new wound site. He wrote me up for extra painkillers and ordered a CT scan to see what was happening and said he would come back to review me. 

Hubby called about 10am and I was in so much pain I could barely form a sentence. After a minute or two I had to put the phone down which must have suitably worried him as he left work and came up to the hospital straight away. 

Not long after he arrived Mr Aziz came back and the pain had gotten worse and spread across the whole tummy area. It was so bad that they had to take me to the CT scan on my bed rather than in a wheelchair and it took 6 people to transfer me from my bed to the CT scanner. 

After lunch Mr Aziz came with the CT scan results but he also brought the surgeon with him, another doctor and the ward sister. When they bring an army of people you know it's probably not good news. 

He explained that the CT scan showed a collection of fluids near the join and given the pain I was in he thought it probable that I had a leak. A leak is not good. In fact it's one of the worst post op complications I could develop. This meant that poo was leaking out from my bowel into my abdomen and this could make me very sick. Or kill me. 

This is where the biology lesson comes in. When they close your Stoma its like sewing 2 bits of hosepipe together except that they are all soft, wiggly and filled with poo. And if there's even so much as a tiny hole left it can cause a leak. 

What was puzzling them though was that my obs (pulse, heart rate, saturation levels) were all in the normal range and my blood tests showed only a minor rise in the infection markers when they would have expected them to be going off the scale. 

The army of medical staff said they were stepping outside to have a professional discussion but they didn't go far and me and hubby were able to hear most of it through the 'sound proof' curtains that surround every bed in the NHS.

When they returned they confirmed our worst fears- I would need to go back to theatre for an emergency operation. They would need to look for the leak and try to fix it. There was a very high chance that I would need to be cut from top to bottom again and that I would wake up with a Stoma, probably on the left side as my right side was recovering from the surgery a few days ago. 

To say I was frightened is an understatement. For the second time in a matter of days I would be going to theatre and wouldn't know what they were actually going to do to me until I woke up. The thought of being cut top to bottom again knowing the pain that would bring was soul destroying. 

But all the medical people said this was the best and safest option, so I was literally putting my life in their hands. 

At this point we decided it might be wise to let my parents know what was happening so hubby went and called them and they packed a bag and started the drive down from Nottingham. 

The surgeon came to consent me and told me they were waiting for a theatre slot; I was on the emergency list. The consent form was pretty scary- we may or may not have to remove more bowel, we may or may not damage some bowel in the operation, we may or may not give you a Stoma, we may or may not kill you... all the standard things you consent for before an operation. 

Just before 4pm they called me down to theatre. I have this thing that I think that if you go to theatre needing a wee you will wake up needing one and there is nothing worse than needing a wee when you've had an op and are in pain and hooked up to a million machines and tubes and wires. 

So given my thinking I decided I was going for a wee. Hubby wanted me to call for a commode but I knew there wouldn't be time before being whisked away so I said I would walk to the loo. On the way back from the loo I saw Mr Aziz heading to theatre and we both smiled at each other. 

What I didn't know was this was a pivotal moment. That him seeing me would change the course of the day. 

Me and hubby were at this point shitting ourselves and he put a message on my Facebook asking any friends that are that way inclined to pray for me as we didn't know what was going to happen in the next 3-4 hours and how bad things could get. 

Mr Aziz came to my bed to see me and said that given the fact I had managed to walk to the loo he wanted to review me one last time before the op. The pain was still severe but had eased slightly and when they do the surgeon tummy tapping thing it didn't make me want to scream and leap off the bed. 

"I think we will pass on this theatre slot" he said. "You seem a little bit better and I don't want to operate on you if I don't have to."

He explained that he wanted to wait and see what happened. If I got worse or any of my obs/blood tests showed I was getting sicker he would take me down. He even promised not to drink that night incase they called him at 1am to operate on me!

Fan-bloody-tastic. Thank you bladder and crazy pre op superstitions!! You just saved me weeks of horrendous pain and my tummy being cut up into a right old mess. 

As the pain was still not being controlled by oral morphine and top up injections they arranged for me to have a PCA (patient controlled anaesthesia) machine- a morphine pump where I press a button whenever I need a shot of pain relief. This really helped with the pain and enabled me to get some rest. 

I think that it can't be coincidental that when everyone started praying I started to get better. Or that the surgeon walked past that loo on the ward at exactly the same time I was coming out of it. Some may call it fate, or divine intervention. All I know is that if I had had the surgery I would be very, very unwell and it would have made my recovery ten times worse. 

NB x