As the symptoms worsened and my bowel became obstructed, we needed to delay surgery in order to reduce the chances of a complication and improve the chances of success. This involved the clever idea of using a temporary colonic stent.
It was now the middle of the summer and things were getting worse. I was still waiting to see the local gastroenterologist. During this period of waiting three months for the appointment, that the episodes of bowel problems became more frequent and more severe. The episodes now took on the form of a large bowel obstruction, causing the backed-up contents of my bowel becoming septic and toxic. This causes the colon to dilate and expand in what is called a toxic megacolon. If a large bowel obstruction is left untreated and unchecked, the bowel can burst. This releases the contents into the abdominal cavity with severe consequences and a risk of death.
Toxic megacolon
The situation culminated in an episode of toxic megacolon while I was on holiday at the end of August. I sent a text message to MS my surgeon, asking if I could see him urgently. I mentioned that I needed to see him anywhere and at any time. Fortunately, he understood exactly what I meant. He was returning back to work from holiday the following day, and would be on call for emergencies the next week. We arranged that we should meet in the hospital the next morning.
It was just as well I acted as MS was extremely worried. He was concerned whether he would have to operate as an emergency that day. He immediately sent me for a CT scan. The scan confirmed the blockage in the sigmoid colon and the dilated and distended large bowel. I had been on antibiotics for 48 hours and the symptoms were getting no worse. We decided that I should go home keep in touch with him and report back in the morning.
The following morning, the storm of symptoms was somewhat calmer and I felt a little bit better. MS suggested that I remain on a very light liquid diet and the antibiotics. We decided that we would see what would happen over the weekend. He suggested that he had an operating slot on Monday morning, which he could use if necessary. The reason we were hesitating with the surgery was that large bowel surgery if undertaken as an emergency is fraught with a high risk of complications and failure. This is because the tissues are inflamed and extremely fragile and may fall apart or become infected. If possible, it is much safer to wait a few weeks for the symptoms settle before operating.
On Sunday I was still very sick, but my stomach was a little better, less distended, less painful. I was not vomiting and had passed some wind. I spoke with PS who was still concerned and he discussed the situation with one of the other bowel surgeons. They came up with a plan, which was unusual as it involved using a device outside the limits of its licence. I had suggested this six months earlier to PS a consultant in London I had seen as a second opinion. He had said that the colonic stent was only used in cases of malignant cancer.
Rescued by a colonic stent
A colonic stent is a tube of plastic or metal mesh which can be rolled up into a thin tube, 2-3 mm in diameter. It is inserted through the narrowed diseased area of the bowel under x-ray screening during a colonoscopy. Once it is in place it is released where it expands, creating an open channel through the blockage. In cases of bowel cancer, it provides relief of the symptoms. The cancer grows into the mesh which holds it in position.
A colonic stent is not generally used for benign diseases such as diverticulitis, because, over time, the stent can dislodge and move up or down in the bowel. The stent can over time also erode through the wall of the bowel and was not threrefore a long term soloution. After several weeks or months the stent also needs to be removed. As it can erode into the bowel wall and perforate it over time. In my situation, we needed a temporary relief of the obstruction, which would then allow things to settle down. The use of the stent seemed an ideal way to achieve this. I was made fully aware that this was not the usual way a stent was used and that the procedure was only a temporary measure. Once things settled down the stent would have to be removed together with the diseased section of my bowel.
In my situation, we needed a temporary relief of the obstruction, which would then allow things to settle down. The use of the stent seemed an ideal way to achieve this.
My weight had dropped further to 87 kg and I became worried when I looked in the mirror and saw how thin, gaunt and ill I looked. It was clear to me that I was very sick and could not avoid major surgery. This diseased section of my large bowel needed to be removed by a sigmoid colectomy. In order to reduce the chance of complications I was, happy to agree to having the colonic stent fitted; knowing that I then had to undergo major surgery a few weeks later.
I had the colonic stent inserted whilst I was awake
MS arranged for me to have the stent put in three days later on Wednesday. The procedure was undertaken as a day case procedure. I was placed in a procedure room in the x-ray department and given some mild sedation. A colonoscopy was performed by MS with a consultant radiologist in attendance. He placed the stent through the blockage, then a little dye, opaque to x-rays was inserted. Radiographs were then taken to ensure that it was properly sited. Once this had been confirmed, the stent was released to unravel. The procedure was completely painless and I was able to watch it on the TV monitor.
Following such procedures, the routine was keeping patients in the hospital overnight. However, this was usually for patients sick with bowel cancer. I was absolutely fine other than the weight loss, malnutrition and bowel obstruction. The stent had immediately opened up a passage, as all the fluid and dye that had been used in the procedure, flowed out a few minutes later. This was a sign that showed that my bowels were beginning to work. I managed to persuade the nurses to discharge me from the hospital the same day at approximately 7 PM. In order to ensure that the stent did not get blocked, I was told to stay on a low-fibre and low-residue diet.
The next morning, I woke up feeling perfectly fit and well. I had arranged to take my mother for a week-long holiday to Amsterdam and this was just as well as our flight was later that morning. Certainly I would not advise other patients to adopt this attitude. I thought that being trained myself and having a benign condition (non-cancerous), which was well-treated, I was perhaps best placed to make the decision. Besides, since I really did feel fine, I didn’t want to alarm or disappoint my 87 year old mother.
