This case report will detail Sarah’s* experience after undergoing an ultra-low anterior resection for rectal cancer around her 59th birthday and her journey using The Insides^® System. This report will focus on Sarah’s decision to reverse her loop ileostomy.

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Introduction

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Sarah was diagnosed with rectal cancer close to her 59th birthday. She required a defunctioning loop ileostomy due to obstructive symptoms from the tumour before undergoing neo adjuvant chemotherapy. She was able to have a radical resection of the tumour once the chemotherapy was complete, six months later. Sarah was told that she needed to lose weight to ensure she had a successful closure surgery, but this proved tough. Sarah had a protruding stoma that didn’t cause her any trouble, so she made the decision to keep the stoma instead. Fast forward four years since the initial formation of Sarah’s stoma and the arrival of The Insides^® System, Sarah was presented with the opportunity to test her bowel function and start a weight loss programme.

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Journey

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Sarah started using The Insides^® System in October 2020 with the 28 Fr edition of The Insides^® Tube. Due to the extended time she had been defunctioned, Sarah started slowly with one small bolus a day for the first week. This kept the bloating and abdominal discomfort to a minimum and she was able to continue completing her daily tasks. In the second week, she increased it to two small boluses a day and had her first bowel movement (BM). By the end of the second week, Sarah was reinfusing three times a day and had her second BM. By the end of the third week, Sarah was reinfusing 85% of her output, had no abdominal discomfort, and was having daily BM’s.

Sarah took some time evaluating her bowel habits and what foods impacted on her BM and frequency. She spent the following two months completing this evaluation until she reached a satisfactory BM routine while using The Insides^® System. Due to having an ultra-low anterior resection, Sarah’s rectal vault capacity was greatly reduced, so allowances needed to be made for her to find a “new normal”. This resulted in a clustered evacuation where she passed two to three BM within an hour, each day. Sarah was happy with this. Sarah’s weight loss programme was successful, and she was able to reduce her weight down to ensure she had the best possible outcome with her closure surgery. Sarah met with her surgeon and her elective closure surgery was booked eight weeks later.

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Conclusion

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Sarah had a successful closure surgery, passed her first BM 36 hours post operatively and was discharged on day three. Sarah had a routine recovery at home and was able to get back into her routine within one month of being at home. Sarah has remained in touch with The Insides^® Company and is very pleased about her outcome.

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