An ostomy is a surgical connection of the bowel through a hole in the abdominal wall which allows the stream of intestinal contents to be diverted.
Nobody likes an ostomy.
Patients don’t like it.
Their families don’t like it.
Nurses don’t like it.
I only like them because they can help save a life.
Ostomies are created for different reasons. Sometimes, a patient is too sick and weak to be able to heal a repair of the intestines. Sometimes, when the colon has become massively dilated as the result of an obstruction or twist of the colon, an ostomy can temporarily divert the fecal stream and allow healing to occur. For an infant born with an imperforate anus, a temporary colostomy can allow the baby to get rid of waste until a new connection of the bowels to the anus can be created.
Since I have been back in Nalerigu, over the past 8 months, I have created several ostomies. In the days immediately postoperatively, ostomies are difficult to clean, the ostomy appliances get dislodged and leak and the skin becomes raw and inflamed. It is a frustrating process for the nurses, the patients and the family. Once the patient and his family can care for the ostomy, their attitude usually changes. The most rewarding aspect is seeing the patient get stronger and healthier and finally return for the closure of his ostomy.
One patient had traveled as a migrant looking to reach Europe in search of work. He was trafficked through the Sahara with little to eat only to be shot once arriving in Libya. The bullet traversed through and through the buttocks, hitting the rectum on its way. Since the injured part of the rectum was inferior to the abdominal cavity, the treatment given was diversion of fecal stream (by creation of an ostomy), drainage of the rectal wounds, and antibiotics. The rest of the healing is left up to the patient’s own immune system and God’s amazing design for wound healing. He lived with this ostomy for 5 years, seeking help in many hospitals before he arrived in BMC and I was able to reverse the ostomy for him. His face beamed when he told me he finally had passed stool once again.
An 8 year old boy presented to BMC after being sick for several weeks. He was malnourished, febrile and his abdomen was severely distended and tender. His abdominal distention pushed up on his diaphragms to the point of affecting his ability to breathe. His abdominal X-ray is an image that I will never forget. Half of the abdomen was full of air and the other half was full of fluid (intestinal content which had leaked out).
When we finally were able to bring him to the operating room, we discovered that not only had Typhoid perforated his small intestines in 2 places, but it had also caused the top of his gallbladder to become gangrenous and open up. This kid was sick. In order to give him the best chance to heal, I decided to give him a loop ostomy at the point of the proximal perforation. I repaired the second hole (knowing that it would have time to heal without seeing intestinal content. For his gallbladder, we removed the dead portion and closed the remainder of the gallbladder around a drain which exited his abdominal wall just under his rib margin.
He remained in the hospital more than a month. He became like a skeleton, but with time, he finally began to heal.
In the days leading up to his discharge home from the hospital, I talked to the father. He related to me that the day I showed him the X-rays, he knew that his son was going to die. I replied by telling him that I also thought the child was going to die, but God answered my prayers to spare his life and I thank Jesus for his compassion.
The father was actually one of my patients 2 years ago. He himself was very sick with an ulcer induced perforation of the stomach. Now, both father and son bear the evidence of my knife… and the evidence of God’s grace that they are still alive.
Four months later, his face has filled out, and he is stronger and fatter. I decided it was time to reverse his ostomy. The excitement that is expressed by a patient when he is once again able to pass bowel movements the way God intended is such a sweet emotion. When something that seems so basic is taken away, but finally restored, gratitude overflows.