Julie's Chyme Reinfusion Experience：

27 August 2022. Emergency admission to Pinderfields Hospital, Wakefield with severe abdominal pain. Initial operation found a tear in the small intestine. Further examination revealed an adhesion which had partially closed the bowel overtime which had caused the blockage which then led to the perforation. Additionally, there was ischemia in a section of the bowel. I had two further operations on the bowel whilst remaining in intensive care (ICU) until 25 September 2022 when I moved onto an acute surgical ward. Total parenteral nutrition (TPN) was commenced immediately after the operation for 24 hours a day for the first 6 weeks, then it was reduced to 12 hours a day. I remained on this ward until 9 October 2022 when I was transferred to the colorectal unit at St James’s Hospital Leeds.

17 October 2022 the colorectal team and nutrition team had a multidisciplinary meeting to discuss the fitting of the Chyme reinfusion system to help me recover. Everything was explained to me, and I was quite willing to have this system fitted.

4 November 2022 Angela Cascarino (Anji), the Colorectal Nurse Specialist explained everything about the system in great detail and the benefits that reinfusion would have on my recovery which included decreased inpatient stay and decreasing or stopping my TPN. She also explained that the pump would need changing every three days and I would have to go back to clinic every 30 days for the tube replacing. I agreed that I would be prepared to do this.

7 November 2022 I had The Insides System inserted into my bowel at the bedside by the Colorectal Nurse Specialist, I then had training from Anji on how to change the pump and stoma bag every three days. It felt strange when the tube was inserted into my bowel, but it did not hurt. Anji explained that my bowel had not worked for ten weeks, and it would take some time for the system to work, and I had to pump the chyme 3 times daily initially. Anji advised me to use the driver on setting 2 but if the contents of the stoma bag were thickened to use setting 3 initially and then reduce to 2. This seemed to work but still had reflux. I was told not to worry about this and simply keep pumping and in time the reflux would reduce. The pump was changed every other day initially but now changed every 3 days as recommended.

23 November 2022. This was the first time I had opened my bowels since admission, so the pump obviously was doing its job despite the reflux, happening each time I reinfuse the chyme.

5 December I was discharged from St James’s Hospital home. My projected discharge date was originally 19 December but I was discharged 2 weeks early and I think this was due to The Insides System reinfusing the chyme into my bowel, which was fantastic. I did go home with TPN as well.

Once home, my daily routine was much the same, the device did not hinder anything that I wanted to do. I still went out shopping and socialising with friends and family. The driver goes with me everywhere and I use it as and when required and do not feel self-conscious.

Since being at home I now pump several times a day and am currently reinfusing approximately 75% - 80% of my chyme daily. My bowel movements have returned to normal daily function.

10 January 2023 I attended the Nutrition clinic with a senior dietician and consultant, Mr Burke. Discussions were had around my lifestyle, eating, mobility and TPN, which I am still having 7 days a week. Since 25 November my weight has increased by 6.2Kg, this is due to reinfusing the chyme back through the system into my bowel, plus eating normally and the TPN. The Dietitian would review my TPN prescription once my blood results were received.

12 January 2023 I received a telephone call from Emma, Senior Dietitian, who explained that my TPN will be reduced to 4 days per week which again is fantastic. This again I think is due to the Insides System providing me with the nutrients required.

My initial thoughts about the device are that it has benefited me greatly in the by allowing me to be discharged home early, my TPN has been reduced, but most importantly having the option of an early reversal of my stoma, which after discussing with Mr Burke, could be a reality.

I also want to thank my husband Mike, who has been my support since my surgery and has been assisting me with tasks around the house, and changing my stoma bag as necessary. He also connects and disconnects my TPN. Since returning home, both my mental health and quality of life have improved.

I can’t thank enough Mr Burke and his team, Angela Cascarino, Colorectal Nurse Specialist, the nutrition team, and the nursing staff on J46 Lincoln Wing at St James’s Hospital, Leeds for their excellent care, attention, and explanation of The Insides System at all times.

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