Dr Pamela Sivathondan
Consultant Colorectal and IBD Surgeon
Daniel is a 33yr old male known to have medically resistant Crohn’s disease affecting his jejunum and terminal ileum. He had been referred to a specialist centre for further management.
He presented with peritonitis and was taken to theatre for an emergency laparotomy. His jejunal Crohn’s had perforated causing peritonitis. At theatre, due to dependence on inotropes and degree of contamination it was not possible to form a primary anastomosis and a double-barrelled jejunostomy was formed with 1.2m small bowel proximal to the jejunostomy.
Daniel made an excellent recovery from surgery with no post op complications and was fit for discharge within 2 weeks. However his stoma output was extremely high, often in excess of 2.5 litres/day. He was started on Loperamide 16mg QDS, Codeine Phosphate 60mg QDS Omeprazole 40mg BD and octreotide but his stoma continued to output an average of 2.5 litres per day and he was completely TPN dependent. His weight had dropped down to 51kg from his admission weight of 60kg.
Daniel had recently become a father for the second time and his baby was only a few months old. His wife was managing their older daughter and new son all by herself at home. Daniel was understandably desperate to be at home and his mental health was starting to suffer.
It was at this point advice was sought from a specialist intestinal failure centre in UK who mentioned ‘The Insides System’.
Individual patient funding from the hospital meant that this became a reality for Daniel.
Daniel was the perfect patient for the system – he was incredibly motivated and keen to learn and complied with everything he was asked to do. He was already managing the stoma admirably.
We were the quickest unit globally to get established with The Insides System. From the time we heard about it to the time we were using it was just a week! The Insides System team were outstanding and Emma facilitated online learning which enabled us to get set up so quickly. Daniel was able to use the system almost immediately as it was so intuitive and he was independent with it within a day.
He managed to wean off TPN and went home a week later. The story captured the interest of the local news and he was a local celebrity for a while. His family were extremely grateful and lots of his friends and family wanted to see Daniel use the device! Furthermore, Daniel managed to go to work with his device which is an amazing feat.
Daniel successfully came off all tablet medications and his bloods normalised over the coming weeks. He gained almost 10kg in weight and after 5 months of using the device finally had his reversal surgery in October 22. His jejunostomy was successfully reversed and also he had his terminal ileal Crohn’s disease resected. His bowel was in excellent health at the time of his reversal surgery. He recovered well from this and was home a week post surgery.
He has continued to gain weight and now weighs 63kg – the most he has weighed in years.
Daniel and his surgeon remain extremely grateful to The Insides System – without it, Daniel would have had stayed in hospital for a further 5 months on TPN until he could have his reversal. The Insides System has made a massive difference to Daniel in terms of quality of life but has also changed the way the hospital manage acute cases – rather than risk anastomoses in high risk cases, a double barrelled stoma and The Insides System gives us a much safer option. Bringing both ends of bowel out onto the skin to allow for The Insides System is also an important surgical practice that has changed.
Emma had an enteroatmospheric fistula form after being involved in a tragic car accident. She used The Insides System for close to 14 months, navigating her way through life as a 20 year old to successfully being reversed this year...
This case study follows Adrienne, a premature infant whose Neonatal Intensive Care stay was complicated by bowel perforations, significant faecal peritonitis and large volume turbid ascites, secondary to a milk curd obstruction. She required a beside laparotomy in the Neonatal Intensive Care Unit (NICU) and her postoperative journey was very difficult, complicated by hypovolemic shock, an aortic clot, a wound dehiscence with a fistula formation, and a further deterioration with septic shock leading to reduced blood flow to her small bowel.
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