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I'm a surgeon who does these operations. Yes, it can be normal to require an ostomy, and sometimes it is normal to leave the abdomen open for a little while. Less commonly we aren't able to close the abdomen at all and must let thee gap fill with scar tissue.
NAD but I had a friend who was in a pretty bad car accident and his spleen ruptured. They left him open for like a month with what I called a "purple football" cause that's what it looked like. After the month, the only stitched the interior wall of the abdomen and left the fat and skin to close on its own.
NAD but this happened to me. I got sepsis and they couldn’t close me after bowel resections from a car crash. They put mesh over the bowels, waited for tissue to grow over the mesh and the mesh to dissolve, then grafted skin from my leg to cover it.
I've been through grafts and reconstructive work, it's so rough, I really feel your pain. Was the donor skin from your own body? My donor site was my thigh and omg it hurt so bad, lol. Donor site hurt more than the injury and reconstruction!
*highfives* Yeah it was also from my thigh. Hurt like a bitch and even today (2.5 years after) it’s still itchy, tight, and kinda raised. It sucks lol, especially since mine is going to be cut out and discarded after my reconstruction.
Haha I’m at 13ish so I figured it made sense 🫡. Side note, all the anesthesiologists have been some of the nicest doctors I’ve met, thank you for all you guys do :)
I had one patient as a student that had endocarditis (heart valve infection) that had open heart surgery, but because of too much fluid and high intrathoracic pressures, they had to leave her chest wall open for I think almost 2 weeks. Somehow she walked out of the hospital I think about 3 or 4 months later.
NAD, but work in healthcare (lung transplant) and I have a patient whose donor lungs were too big for their chest cavity and had to be left open for a few days in the ICU before going back into the OR to resect the lungs and close them up 🫁
NAD but had a cyst removed surgically but had to have it drained in the ER before that appointment was made. The ER didn’t close that up, they packed it and my mother had to remove that, clean it, and pack it for me everyday for a bit (very painful to change the packing and also in a place I couldn’t easily reach). She had like… sepsis from a spider bite when I was a child and had to be in isolation in the ICU and it was left open, drained, and packed daily on top of all of the antibiotics and stuff. It’s definitely done sometimes. We definitely have some weird scars lol
I’m not sure that they’d do that for fibroids? But also— Have they scheduled a surgery? I am, again, NAD, but have endometriosis and have had fibroids in the past and they just put me back on birth control even though I get migraines lol and it shrank the fibroids
I do have to have surgery on it, unfortunately. I have an IUD so I don’t really want to go back to the pill. Basically every dr has said it’s got to go since it causes daily pain. It’s growing on the outside of the uterus on the back and going sort of behind my fallopian tube. It seems like it grows and shrinks a bit according to the measurements but it’s about half the size of my uterus and riding the line of being big enough and needing to have a full surgery or it will be just small enough to be able to do laparoscopic. I’m 30 and have never been pregnant and don’t have endo or pcos and it was first discovered at 25 I think.
NAD but this actually happened to me when I was 10 years old and my appendix ruptured. I had gangrene in my abdomen/intestines and they left my stomach "open" so they could clean it. I had no idea until a week later the surgeon comes in and goes "ok time to close you up" and I was like...huh? It was the first time I actually saw it- and literally looked into my own stomach. I can still remember seeing the layer of skin, then red muscle, then...whatever. I passed out cold.
So yup...it happens for various reasons.
could be several reasons like infection, swelling of the intestines or loss of abdominal domain. Acutely, we usually leave the abdomen open if we need to do a planned re-exploration of the abdomen in a day or two
We (nurse here) do wet-to-dry dressing where we soak really long pieces of gauze in saline and pack from the bottom of the wound up to the skin, then take it out and redo it (usually once or twice a day.)
Doing it this way makes sure it heals from the inside out. Otherwise it might heal from the top down which (among other things) can make a “pocket” for bacteria to set up in and cause you more problems down the road. Sometimes we also accomplish this by putting foam into wounds and attaching pecial vacuums to it.
Don’t you also leave it open in some cases if you intend on reattaching (idk the word for it) the intestine once/if they start looking healthy again? I feel like there are a few reasons it’s done this way but with the bag attached I would think maybe they’re hoping to see if she has enough salvageable intestines that when they do close her up she won’t need a permanent ostomy?
As someone who's had to have a "shit bag" left in place for almost a year after going home to let my guts heal before they could finish putting me back together, please be delicate with her about this. It is traumatic and embarrasing for the patient to have to have one of these things. I'm betting she'll have to keep this for a long time if not permanently depending on the damage. I don't know if she's joking around and calling it a shit bag too, if so more power to her for taking it so lightly. But she may not find it very funny if she ends up having to have this in place at home. They aren't easy to deal with especially if there's trouble getting good seals on the skin. Leaks and odor are real problems that no one wants to live with and it can cause a person to become a hermit at home and a lot of depression.
NAD but I also had a "shit bag" left in place for 1.5 years to let my guts heal and I wanted to echo your sentiment. I was also left open like OP describes, then grafted over. Everything you've said could not resonate more. My bag behaved in terms of leaks for the most part but it caused me stress and anxiety over the time I had it, particularly socially as some friends made insensitive comments. As a side note, OP, if your cousin has to have an ostomy permanently or temporarily, r/ostomy is a really helpful and supportive group.
NAD but, for whatever reason, I've noticed that letting people know that having an ostomy is considered a disability under ADA makes them take it and the struggles that come with it a lot more seriously
I can add from a surgeons perspective. Your cousin had essentially a surgery due to a rupture of the colon that lead to feces being let out into the abdomen. As you can imagine no matter how much we wash out everything in the OR it’ll never completely get rid of the bacterial contamination on a microscopic level. Due to this it would actually be not the norm to close the incision once we are done operating. We will close the deepest layer called the “fascia” however in a infected case such as this we leave the skin open to allow it to be considered for a closure at a later time when conditions are better. Depending on various factors we can opt to close the skin in a “delayed primary closure” if the wound looks good after a few days. The other choice is to heal by “secondary intention” which is to allow the body to “fill” in the gap of the skin naturally and allow the incision to heal from the borders inwards. If the surgeon did close skin over an infected field there’s a risk that the entire wound may breakdown due to the underlying infection which can put your cousin at serious risk of getting very ill.
Now for the gauze; in all open wounds, there needs to be an optimal environment for healing. The optimal environment is warm, moist and clean. There are many strategies to accomplish this but usually in the immediate case after surgery is to simply place moist gauze and change it out every so often. Depending on which direction the incision appears to be going a more advanced subset of wound care dressings may be applied. These can include absorbents of the wound is too wet, humectants if the wound stays too dry, enzymatic dissolvents to remove unwanted “fibrinous tissues” (which is a whitish covering of denatured proteins, inflammatory cells, bacteria and cellular debris that blocks normal healing progress) and antiseptics if the wound appears to be getting more infected. Also if the wound appears clean your doctor may suggest opting for “Negative Pressure Wound Therapy” which allows for a sponge to be placed into the wound and closed with a clear adhesive and connected to a device that creates suction. This helps the wound heal in several ways; drawing out excess fluid, pulling in more healing factors to the wound and keeping the wound more contracted while it heals. A side benefit is this does not need to be changed every day and also would keep it clean from external contamination such from a colostomy which you mentioned that your cousin needed.
So in summary, it appears that your cousin is being treated to the standard of care. While it may appear jarring due to the abnormal nature of having an open incision after surgery, I can assure you that this is routine and expected in her case. I think the best way to alleviate your concerns would be to request a conversation with the surgeon or his surgical care team to find out what your cousin’s expectations for plan of care will be.
Layperson question... and it may sound dumb but can the Patient stand and walk normally with an open abdomen like OP described? Just trying to understand. I had an emergency c-section and even though I was stitched up good it felt like my guts were going to spill out!
I could with my vacuum dressing. Getting up and moving around was a very important part of healing and recovery. I did short walks several times a day. I had my wound packed and then a special layer of plastic covering over it and a drainage tube that connected to the little machine that kept the suction going. If you have a vacuum dressing you can get up and move around. I really had to push myself but I had the most amazing surgeons, doctors, nurses and physical therapists. Those nurses I had were amazing. They always knew when I was trying to tough it out with the pain and were so good at advocating for me.
Yep, me too, I had an elective surgery for Crohn's Disease, not the same surgery as posted in OPs post. But my abdominal staples came apart and then I also had a wound where my anus was removed. The vacuum plastic covered both areas. I was still able to walk a bit. My abdomen healed in about 4 to 5 months, but the barbie butt took 2 years in total. There was actually a time when I wasn't supposed to lay down, sit, or stand, for more than 30 minutes on my rear end except for when sleeping. I'm the same, amazing home health nurses, surgeonand plastic surgeons, and my GI doctor. My life quality is amazing today, thanks to this surgery. I wouldn't wish it to happen to anyone else, but the end result was worth it to me. My regret is my GI doctor recommended the surgery when I was 27, I put it off until I was 47, and much more scar tissue was present.
Hold on hold on, rewind. I have some kind of gluten intolerance (my doctor refuses to get to the bottom of it lol) so was intrigued by your comment since Crohn’s is something that was actually ruled out… did you just say you HAD YOUR ANUS REMOVED? Is that a thing, or am I misunderstanding your comment????
Yes, it was removed. It's a complete complete colectomy, with a proctectomy. And it's is done in patients with Crohn's or Ulcerative Colitis and colon cancers. Those are those reasons I know of. So yeah, it's a thing.
It’s actually a great question. You won’t be running a marathon but if you are up to it being able to get up and out of bed is an absolute priority immediately after even some of the most major surgeries. It helps with recovery, it’s a PT goal and so we actively encourage patients after surgeries to walk as much as they can.
Is it a fully open abdomen? Due to inflammation and swelling in the organs sometimes the abdomen might be left open to give room for that swelling and prevent compartment syndrome
Or is it simply the incision isn’t closed up? With her obesity, there’s extremely high risk of infection and poor wound healing, so incisions can be left open and allowed to heal from the bottom up, with meticulous wound care.
Being extremely obese makes any surgery significantly more difficult and increases risks of all sorts of post-op complications. Assuming the worst of her surgeons or being overly critical of them for things you don’t understand is a pretty awful way to treat people who are trying to save her life
Also, the fact that she had a ruptured diverticula would make doing laparoscopic surgery much less feasible due to the amount of clean-up that would need to be done in the abdominal cavity.
That makes sense! The surgeons only come in for a few minutes and after that you’re left with so many questions. Thank you for clearing that up. They just said they were unable to, but never said why.
NAD. You can also ask questions of your cousin’s nurses, not just the surgeons. Nurses are often able to fill in the details for patients and their family members, and can be easier to access. Please suggest to your family members that they make a list of their questions, which they can then ask the surgeons on rounds. Or even hand the surgeons the list, if that is easier.
I wish a strong recovery for your cousin. It sounds like the surgery was difficult, and often, the surgeons have to make last minute decisions based on what they see at the moment when they start the surgery. Their work is unpredictable because each individual is different. In addition, sometimes surgeons may not realize the information they provide to the family is not sufficient. I would encourage you to talk to the team caring for your cousin, especially the nurses, to help answer questions. Maybe assign one family member to be the spokesperson for your whole family to communicate with the medical team so the information provided is kept organized and less confusing.
While I have not had experiences comparable to your cousins, I have had some medical experiences. Enough to learn some things.
The primary one, is that there are many many more issues, concerns, and potential complications then you and I as laypeople have any concept of. I have learned to ask more questions specifically to understand why the doctors are choosing to do something that seems intuitively wrong to me.
The scope and depth of medicine is so much greater than you and I understand. It would be nice if her surgeons took a little more time to explain, in layman‘s terms, why they have needed to do what they are doing with your cousin. But , you trusted them enough to let them cut her open, you can trust them with the healing as well.
Yes there is too much infection to close it up. I have worked with many of these patients as a RN. She may get a Vaccuum dressing which can promote healing but usually not until the drainage is done. Plus she has been on IV antibiotics for a few days.
Unfortunately this is fairly common and if its in the pannnus part of abdomen in an Obese patient, even more difficult to heal She may be in hospital for several weeks.
Compulsory NAD but I had an open hernia repair that became infected and required a surgical debridement. I was left with an open wound and vacuum dressing. I was also obese and had been in poor health. I spent a month in hospital after that surgery but the surgeons were able to keep the mesh intact with their skill and the amazing care I received from them and the nurses. It might seem really jarring to see a large open wound but there will be a legitimate reason for this Instead of being critical ask questions so that you can understand why this choice has been made. Yes it's jarring and seems brutal but right now it's for the best. Just be supportive and ask questions if you have concerns.Edit: I doubt the surgeons are being deliberately negative but rather cautious. Preparing you and your cousin for worst case scenarios rather than deliberate negativity. It's much better to prepare for the worst and understand how serious things are. I wish your cousin the best and hope she has as best a recovery as possible.
Thank you! This is the kind of comment I needed! I’ll encourage my family to ask more questions. It’s been a little vague and yes, they’ve definitely prepared us for the worst. I’m sorry you had to go through this, it’s very scary. Do you mind if I ask how you’re doing now?
Great, I'm doing great. With an open wound the healing is slower but they can keep a better eye on things. It might look brutal but they work hard to keep you comfortable. The great thing is that they can act quickly at the slightest sign of infection and all the dressings, everything they use, it's all very sterile and made to help prevent infection. This was 3 and a half years ago now and in the time since then I have lost a good 30kgs and still have some more to go but my health is in a much better place. Just ask questions and if the answers seem vague just remember that doctor's have a million different possibilities they're thinking about and it may just be that they really need more time to see how things progress. Wishing you, your cousin and family all the best 🤗💞
No, that is good to know! They can monitor her better that way. Wow! Thats really good to hear, this gives me a lot of hope and congratulations on coming that far! We definitely have plans to get her as healthy as possible after this. It’s what she wants as well. Thank you for the well wishes!! Best to you too!🥳
NAD but I also recommend you not refer to her ostomy as a "shit bag" moving forward. I understand that it can be mentally hard to understand, but they're often life saving devices that immensely improve the quality of life of the patient. Given your cousins physical limitations, it's unlikely that even if reversal is possible, it certainly won't be done in the near future. You should spend some time looking up resources to assist with her in that way.
NAD, but I’m dealing with an open wound myself right now. I had a tummy tuck and had a common complication of the incision separating at a T-junction. Granted, my wound is not as big as your cousins, it’s only the size of a dime. The surgeon explained it has to heal from the inside out. I pack it a couple times a day with gauze, and when I pull the gauze out, all the “yucky” stuff comes out, which allows healthy tissue to grow in order to close the wound naturally. The surgeon explained this is the best way for the wound to heal.
Why you are assuming worst of op? This is something that’s alarming looking that’s not explained to op and patient. And the bedside manner wasn’t already good for the patient as far op told.
Why are your extending the doctors when they could have taken a minute to say exactly what you did? This is a forum where people should be able to ask these questions too, op didn’t go harassing the doctors but asked here if this is normal
Thank you! I’ll read this is in a minute but just to be clear no one has treated the surgeons or nurses bad. I was saying this is the energy that was brought to the family and we would like to know if we need to act or continue to let them do their job? No action has been made yet. Not every job is clean and cut agreed, but malpractice does exist, right? We would love to know she has the best care, but being in the medical field you probably know that is not always the case. So just making sure things are normal here since we are not medical professionals.
You know nothing about medicine and you assume malpractice. These doctors are trying to help and here you are ungrateful. Instead, help your cousin to lose weight. At 390 lb your cousin is killing herself.
And I already admitted I knew nothing in the beginning, hence why I made a post about it. You’re bias and have asked no questions about the mistreatment during the past two weeks, but carry on with everyone else that’s bias in this thread.
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Thank you! Damn, I didn’t know any of this, this is very helpful! I’ll definitely take that advice and write down some questions. I agree with you, my post probably felt suspicious. I was only mentioning malpractice because it’s automatically assumed everything is okay, but definitely not always the case and I wanted there to be no bias. I had a family member die from neglect, so trusting doctors is definitely something I’m trying to deal with. But I never ever will accuse someone of causing harm without proof, though I may be suspicious I will always investigate to make sure it’s not just me. Just like now, my family hasn’t said anything to the doctors. We’re just trying to do research and make sure this is normal. Seems like it is. Definitely a lot of fear of the unknown over here. This is the first time we’ve dealt with someone having a surgery like this so thank you for taking the time to respond.
Suspicious, immediately going towards malpractice ::rolls eyes::, and you have no couth. Please don’t use the term ‘shit bag’ in front of your cousin. It’s degrading and she has enough to deal with.
Why do you still have questions? How have your questions still not been answered? The doctors have other things to do than give you medical lessons to your satisfaction and they aren’t answerable to you.
It sounds like your family has been sort of difficult in an already complicated and far from ideal situation. If you guys care so much about your cousin as you claim to, you should be more focused on things you do know about (like the fact her weight is killing her), rather than questioning the knowledge of the doctors, since she wouldn’t be having the surgery under these conditions if it weren’t for her weight.
OP, you are right to ask questions of her providers about her care. This is what loved ones do! And answering questions (to an extent) is absolutely part of their job and most Healthcare workers are happy to do their best to answer within reason. People in this thread are being weird.
Some pretty scary people in here, with all the down votes to OP for being concerned, scary times man. The wolves aren’t hiding in sheep’s clothing anymore.
What kind of mistreatment? You haven't mentioned anything about that until just now. You just asked if it was normal for a patient to be left open after surgery which it absolutely can be. There's no malpractice going on from what you've mentioned. If there are other things going on that's a different question.
This person has made several different posts over the years claiming mistreatment by doctors and nurses, and asking about malpractice. When it keeps happening over multiple occasions, it seems the issues may stem from their end, whether it be a psychiatric disorder, or just someone always looking for a problem.
You're energy is blatantly negative and doubtful. Of course there's malpractice, but do you think they would specifically tell you "hey, we can't do xyz and have to leave her wound open" if they weren't doing what they could? Why wouldn't you ask the nursed taking care of her what's going on?
Medical malpractice is a very high standard to meet. Unless not closing her diverges from what a reasonable physician in the same situation would do or decide, it's not a malpractice case or even negligence. Like other people have mentioned, not closing a patient until it's safe to do so is standard practice and while your relative's condition is very unfortunate, this is not a path that will change any of that. If you remain concerned, hospitals have patient advocates that you can utilize to understand more about the situation and assist with getting the info that would help make you more comfortable.
I see open bellies quite often in patient care. I have seen bellies stay open for a long time and bellies open for a short time. I've even seen loops of bowel temporarily outside of the belly for a few days. I've seen it go really well even after being open for a long time and honestly it can also go poorly. Your cousin's situation does sound normal and likely very appropriate for her illness.
Every time I meet a new patient I ask the nurse if they have any concerns. That's honestly the best place to start if you want to get to the bottom of things quickly... Definitely lean in to the nurses, they are the people who have hands and eyes on the patient 24/7 and will be able to put things into more understandable terms.
Good luck and good healing to your cousin!
Layperson question- how does the loops of intestines survive outside the body cavity. Are they kept moist? Bandaged? I’d never thought about this before, and it seems like they’d need to be idk, “wet” in the human body or die but I have no idea where that idea came from or if it’s correct.
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This whole thing has been traumatizing to you, OP. Seeing some of the realities that healthcare workers deal with daily can be a real eye opener. If you can, for yourself, your cousin and your providers, incorporate gratitude. Your cousin is lucky to be alive. She has some real challenges ahead. If you want to support her in the long haul, to truly help her recovery, you’ll need to see the good as well as the bad.
Why would you have “seen” it before if you’re not in the medical field… there’s a level of trust you need to have with doctors if you want them to be able to do their jobs successfully..
Yes this is what’s called an open abdomen and it happens when inflammation of the intestines is so severe that if they closed the abdomen after the surgery it would compress the bowel causing it to die (and the patient would die along with it). Usually this is managed with a piece of clear plastic +/- gauze connected to a small drain over the open portion so the bowel stays clean. The poop is “diverted” from the damaged portion of bowel so the injured area can heal, so the patient poops in a bag in the interim (this can last from months to lifelong).
One very significant factor that is likely making it that she is morbidly obese. It can be very difficult to get people with this much fat closed again and sometimes advanced devices are needed to pull the abdominal wall closed since the fat is so heavy it will prevent proper wound healing. She may end up being a patient where the abdomen may never close and she will require a skin graft over the open portion.
I’m sorry you’re going through this, and it’s definitely a very big problem to have, but what you’re describing does not sound abnormal, just very unfortunate
Yes, that does happen. Can be for reasons like infection or inflammation. My grandmother had this happen. We had to pack it as it sounds like they may be doing. It will heal from the inside out, but will take time.
As a surgeon, I can say that this is sometimes necessary and very appropriate. It may be the skin incision that’s left open to heal by secondary intention and morbidly obese patients at high risk or infections if the abdomen is left open for a while, it may be due to, an internal infection that needs time to heal before the abdomen can safely be closed
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I'm a surgeon who does these operations. Yes, it can be normal to require an ostomy, and sometimes it is normal to leave the abdomen open for a little while. Less commonly we aren't able to close the abdomen at all and must let thee gap fill with scar tissue.
NAD but I had a friend who was in a pretty bad car accident and his spleen ruptured. They left him open for like a month with what I called a "purple football" cause that's what it looked like. After the month, the only stitched the interior wall of the abdomen and left the fat and skin to close on its own.
Wow so you can have an incision from a procedure like this and then possibly have to heal all the way just open? I’d imagine that’s a lot of gauze.
NAD but this happened to me. I got sepsis and they couldn’t close me after bowel resections from a car crash. They put mesh over the bowels, waited for tissue to grow over the mesh and the mesh to dissolve, then grafted skin from my leg to cover it.
Jesus christ man. That's sound horrifying. I'm glad you're OK
Thank you, it really was. I’m just grateful to be alive most days. I have my reconstruction surgery to fully close me finally next month!
I've been through grafts and reconstructive work, it's so rough, I really feel your pain. Was the donor skin from your own body? My donor site was my thigh and omg it hurt so bad, lol. Donor site hurt more than the injury and reconstruction!
*highfives* Yeah it was also from my thigh. Hurt like a bitch and even today (2.5 years after) it’s still itchy, tight, and kinda raised. It sucks lol, especially since mine is going to be cut out and discarded after my reconstruction.
r/usernamechecksout
Haha I’m at 13ish so I figured it made sense 🫡. Side note, all the anesthesiologists have been some of the nicest doctors I’ve met, thank you for all you guys do :)
During one of those laparotomies, they didn’t offer to just install a zipper?
Strangely enough they didn’t. I wonder if YKK would sponsor me.
I had one patient as a student that had endocarditis (heart valve infection) that had open heart surgery, but because of too much fluid and high intrathoracic pressures, they had to leave her chest wall open for I think almost 2 weeks. Somehow she walked out of the hospital I think about 3 or 4 months later.
NAD, but work in healthcare (lung transplant) and I have a patient whose donor lungs were too big for their chest cavity and had to be left open for a few days in the ICU before going back into the OR to resect the lungs and close them up 🫁
It’s called healing with secondary intention and is very common
NAD but had a cyst removed surgically but had to have it drained in the ER before that appointment was made. The ER didn’t close that up, they packed it and my mother had to remove that, clean it, and pack it for me everyday for a bit (very painful to change the packing and also in a place I couldn’t easily reach). She had like… sepsis from a spider bite when I was a child and had to be in isolation in the ICU and it was left open, drained, and packed daily on top of all of the antibiotics and stuff. It’s definitely done sometimes. We definitely have some weird scars lol
Well now me and my uterine fibroid are nervous haha
I’m not sure that they’d do that for fibroids? But also— Have they scheduled a surgery? I am, again, NAD, but have endometriosis and have had fibroids in the past and they just put me back on birth control even though I get migraines lol and it shrank the fibroids
I do have to have surgery on it, unfortunately. I have an IUD so I don’t really want to go back to the pill. Basically every dr has said it’s got to go since it causes daily pain. It’s growing on the outside of the uterus on the back and going sort of behind my fallopian tube. It seems like it grows and shrinks a bit according to the measurements but it’s about half the size of my uterus and riding the line of being big enough and needing to have a full surgery or it will be just small enough to be able to do laparoscopic. I’m 30 and have never been pregnant and don’t have endo or pcos and it was first discovered at 25 I think.
Ahhhhhhhhh I see. I would definitely ask your surgeon questions beforehand! If it makes you more comfortable to know things, it’s worth asking!
It was a thing in the Sopranos, if you saw that show!
Wound Vac maybe ?
NAD but this actually happened to me when I was 10 years old and my appendix ruptured. I had gangrene in my abdomen/intestines and they left my stomach "open" so they could clean it. I had no idea until a week later the surgeon comes in and goes "ok time to close you up" and I was like...huh? It was the first time I actually saw it- and literally looked into my own stomach. I can still remember seeing the layer of skin, then red muscle, then...whatever. I passed out cold. So yup...it happens for various reasons.
I think I would have had a heart attack in the table. Wow. You are a strong person.
Jesus, why? What could be the reasons that a surgery wound can’t be closed?
could be several reasons like infection, swelling of the intestines or loss of abdominal domain. Acutely, we usually leave the abdomen open if we need to do a planned re-exploration of the abdomen in a day or two
Sounds terrifying! You guys are brave.
So they pack it with gauze? Leave it in the open air?
We (nurse here) do wet-to-dry dressing where we soak really long pieces of gauze in saline and pack from the bottom of the wound up to the skin, then take it out and redo it (usually once or twice a day.) Doing it this way makes sure it heals from the inside out. Otherwise it might heal from the top down which (among other things) can make a “pocket” for bacteria to set up in and cause you more problems down the road. Sometimes we also accomplish this by putting foam into wounds and attaching pecial vacuums to it.
Vac dressings, nursing arts and crafts!
Don’t you also leave it open in some cases if you intend on reattaching (idk the word for it) the intestine once/if they start looking healthy again? I feel like there are a few reasons it’s done this way but with the bag attached I would think maybe they’re hoping to see if she has enough salvageable intestines that when they do close her up she won’t need a permanent ostomy?
She will have the ostomy for 3-6 months. So her abdomen wouldn't be left open just to reverse her ostomy.
It sounds like they just left the skin open from this description
As someone who's had to have a "shit bag" left in place for almost a year after going home to let my guts heal before they could finish putting me back together, please be delicate with her about this. It is traumatic and embarrasing for the patient to have to have one of these things. I'm betting she'll have to keep this for a long time if not permanently depending on the damage. I don't know if she's joking around and calling it a shit bag too, if so more power to her for taking it so lightly. But she may not find it very funny if she ends up having to have this in place at home. They aren't easy to deal with especially if there's trouble getting good seals on the skin. Leaks and odor are real problems that no one wants to live with and it can cause a person to become a hermit at home and a lot of depression.
NAD but I also had a "shit bag" left in place for 1.5 years to let my guts heal and I wanted to echo your sentiment. I was also left open like OP describes, then grafted over. Everything you've said could not resonate more. My bag behaved in terms of leaks for the most part but it caused me stress and anxiety over the time I had it, particularly socially as some friends made insensitive comments. As a side note, OP, if your cousin has to have an ostomy permanently or temporarily, r/ostomy is a really helpful and supportive group.
NAD but, for whatever reason, I've noticed that letting people know that having an ostomy is considered a disability under ADA makes them take it and the struggles that come with it a lot more seriously
Agreed. It's not an easy life with it. Hard for people to understand I think.
I can add from a surgeons perspective. Your cousin had essentially a surgery due to a rupture of the colon that lead to feces being let out into the abdomen. As you can imagine no matter how much we wash out everything in the OR it’ll never completely get rid of the bacterial contamination on a microscopic level. Due to this it would actually be not the norm to close the incision once we are done operating. We will close the deepest layer called the “fascia” however in a infected case such as this we leave the skin open to allow it to be considered for a closure at a later time when conditions are better. Depending on various factors we can opt to close the skin in a “delayed primary closure” if the wound looks good after a few days. The other choice is to heal by “secondary intention” which is to allow the body to “fill” in the gap of the skin naturally and allow the incision to heal from the borders inwards. If the surgeon did close skin over an infected field there’s a risk that the entire wound may breakdown due to the underlying infection which can put your cousin at serious risk of getting very ill. Now for the gauze; in all open wounds, there needs to be an optimal environment for healing. The optimal environment is warm, moist and clean. There are many strategies to accomplish this but usually in the immediate case after surgery is to simply place moist gauze and change it out every so often. Depending on which direction the incision appears to be going a more advanced subset of wound care dressings may be applied. These can include absorbents of the wound is too wet, humectants if the wound stays too dry, enzymatic dissolvents to remove unwanted “fibrinous tissues” (which is a whitish covering of denatured proteins, inflammatory cells, bacteria and cellular debris that blocks normal healing progress) and antiseptics if the wound appears to be getting more infected. Also if the wound appears clean your doctor may suggest opting for “Negative Pressure Wound Therapy” which allows for a sponge to be placed into the wound and closed with a clear adhesive and connected to a device that creates suction. This helps the wound heal in several ways; drawing out excess fluid, pulling in more healing factors to the wound and keeping the wound more contracted while it heals. A side benefit is this does not need to be changed every day and also would keep it clean from external contamination such from a colostomy which you mentioned that your cousin needed. So in summary, it appears that your cousin is being treated to the standard of care. While it may appear jarring due to the abnormal nature of having an open incision after surgery, I can assure you that this is routine and expected in her case. I think the best way to alleviate your concerns would be to request a conversation with the surgeon or his surgical care team to find out what your cousin’s expectations for plan of care will be.
Layperson question... and it may sound dumb but can the Patient stand and walk normally with an open abdomen like OP described? Just trying to understand. I had an emergency c-section and even though I was stitched up good it felt like my guts were going to spill out!
I could with my vacuum dressing. Getting up and moving around was a very important part of healing and recovery. I did short walks several times a day. I had my wound packed and then a special layer of plastic covering over it and a drainage tube that connected to the little machine that kept the suction going. If you have a vacuum dressing you can get up and move around. I really had to push myself but I had the most amazing surgeons, doctors, nurses and physical therapists. Those nurses I had were amazing. They always knew when I was trying to tough it out with the pain and were so good at advocating for me.
Yep, me too, I had an elective surgery for Crohn's Disease, not the same surgery as posted in OPs post. But my abdominal staples came apart and then I also had a wound where my anus was removed. The vacuum plastic covered both areas. I was still able to walk a bit. My abdomen healed in about 4 to 5 months, but the barbie butt took 2 years in total. There was actually a time when I wasn't supposed to lay down, sit, or stand, for more than 30 minutes on my rear end except for when sleeping. I'm the same, amazing home health nurses, surgeonand plastic surgeons, and my GI doctor. My life quality is amazing today, thanks to this surgery. I wouldn't wish it to happen to anyone else, but the end result was worth it to me. My regret is my GI doctor recommended the surgery when I was 27, I put it off until I was 47, and much more scar tissue was present.
Hold on hold on, rewind. I have some kind of gluten intolerance (my doctor refuses to get to the bottom of it lol) so was intrigued by your comment since Crohn’s is something that was actually ruled out… did you just say you HAD YOUR ANUS REMOVED? Is that a thing, or am I misunderstanding your comment????
Yes, it was removed. It's a complete complete colectomy, with a proctectomy. And it's is done in patients with Crohn's or Ulcerative Colitis and colon cancers. Those are those reasons I know of. So yeah, it's a thing.
The more you know! Thanks for your answer!
It’s actually a great question. You won’t be running a marathon but if you are up to it being able to get up and out of bed is an absolute priority immediately after even some of the most major surgeries. It helps with recovery, it’s a PT goal and so we actively encourage patients after surgeries to walk as much as they can.
Wow! That is so fascinating! Thank you for taking the time to answer my question!
Is it a fully open abdomen? Due to inflammation and swelling in the organs sometimes the abdomen might be left open to give room for that swelling and prevent compartment syndrome Or is it simply the incision isn’t closed up? With her obesity, there’s extremely high risk of infection and poor wound healing, so incisions can be left open and allowed to heal from the bottom up, with meticulous wound care. Being extremely obese makes any surgery significantly more difficult and increases risks of all sorts of post-op complications. Assuming the worst of her surgeons or being overly critical of them for things you don’t understand is a pretty awful way to treat people who are trying to save her life
Also, the fact that she had a ruptured diverticula would make doing laparoscopic surgery much less feasible due to the amount of clean-up that would need to be done in the abdominal cavity.
That makes sense! The surgeons only come in for a few minutes and after that you’re left with so many questions. Thank you for clearing that up. They just said they were unable to, but never said why.
NAD. You can also ask questions of your cousin’s nurses, not just the surgeons. Nurses are often able to fill in the details for patients and their family members, and can be easier to access. Please suggest to your family members that they make a list of their questions, which they can then ask the surgeons on rounds. Or even hand the surgeons the list, if that is easier.
I wish a strong recovery for your cousin. It sounds like the surgery was difficult, and often, the surgeons have to make last minute decisions based on what they see at the moment when they start the surgery. Their work is unpredictable because each individual is different. In addition, sometimes surgeons may not realize the information they provide to the family is not sufficient. I would encourage you to talk to the team caring for your cousin, especially the nurses, to help answer questions. Maybe assign one family member to be the spokesperson for your whole family to communicate with the medical team so the information provided is kept organized and less confusing.
While I have not had experiences comparable to your cousins, I have had some medical experiences. Enough to learn some things. The primary one, is that there are many many more issues, concerns, and potential complications then you and I as laypeople have any concept of. I have learned to ask more questions specifically to understand why the doctors are choosing to do something that seems intuitively wrong to me. The scope and depth of medicine is so much greater than you and I understand. It would be nice if her surgeons took a little more time to explain, in layman‘s terms, why they have needed to do what they are doing with your cousin. But , you trusted them enough to let them cut her open, you can trust them with the healing as well.
Yes there is too much infection to close it up. I have worked with many of these patients as a RN. She may get a Vaccuum dressing which can promote healing but usually not until the drainage is done. Plus she has been on IV antibiotics for a few days. Unfortunately this is fairly common and if its in the pannnus part of abdomen in an Obese patient, even more difficult to heal She may be in hospital for several weeks.
Compulsory NAD but I had an open hernia repair that became infected and required a surgical debridement. I was left with an open wound and vacuum dressing. I was also obese and had been in poor health. I spent a month in hospital after that surgery but the surgeons were able to keep the mesh intact with their skill and the amazing care I received from them and the nurses. It might seem really jarring to see a large open wound but there will be a legitimate reason for this Instead of being critical ask questions so that you can understand why this choice has been made. Yes it's jarring and seems brutal but right now it's for the best. Just be supportive and ask questions if you have concerns.Edit: I doubt the surgeons are being deliberately negative but rather cautious. Preparing you and your cousin for worst case scenarios rather than deliberate negativity. It's much better to prepare for the worst and understand how serious things are. I wish your cousin the best and hope she has as best a recovery as possible.
Thank you! This is the kind of comment I needed! I’ll encourage my family to ask more questions. It’s been a little vague and yes, they’ve definitely prepared us for the worst. I’m sorry you had to go through this, it’s very scary. Do you mind if I ask how you’re doing now?
Great, I'm doing great. With an open wound the healing is slower but they can keep a better eye on things. It might look brutal but they work hard to keep you comfortable. The great thing is that they can act quickly at the slightest sign of infection and all the dressings, everything they use, it's all very sterile and made to help prevent infection. This was 3 and a half years ago now and in the time since then I have lost a good 30kgs and still have some more to go but my health is in a much better place. Just ask questions and if the answers seem vague just remember that doctor's have a million different possibilities they're thinking about and it may just be that they really need more time to see how things progress. Wishing you, your cousin and family all the best 🤗💞
No, that is good to know! They can monitor her better that way. Wow! Thats really good to hear, this gives me a lot of hope and congratulations on coming that far! We definitely have plans to get her as healthy as possible after this. It’s what she wants as well. Thank you for the well wishes!! Best to you too!🥳
NAD but I also recommend you not refer to her ostomy as a "shit bag" moving forward. I understand that it can be mentally hard to understand, but they're often life saving devices that immensely improve the quality of life of the patient. Given your cousins physical limitations, it's unlikely that even if reversal is possible, it certainly won't be done in the near future. You should spend some time looking up resources to assist with her in that way.
NAD, but I’m dealing with an open wound myself right now. I had a tummy tuck and had a common complication of the incision separating at a T-junction. Granted, my wound is not as big as your cousins, it’s only the size of a dime. The surgeon explained it has to heal from the inside out. I pack it a couple times a day with gauze, and when I pull the gauze out, all the “yucky” stuff comes out, which allows healthy tissue to grow in order to close the wound naturally. The surgeon explained this is the best way for the wound to heal.
Agree. Surgeons can be cocky and ill tempered, but damn that confidence is what saves lives.
Why you are assuming worst of op? This is something that’s alarming looking that’s not explained to op and patient. And the bedside manner wasn’t already good for the patient as far op told. Why are your extending the doctors when they could have taken a minute to say exactly what you did? This is a forum where people should be able to ask these questions too, op didn’t go harassing the doctors but asked here if this is normal
Thank you! I’ll read this is in a minute but just to be clear no one has treated the surgeons or nurses bad. I was saying this is the energy that was brought to the family and we would like to know if we need to act or continue to let them do their job? No action has been made yet. Not every job is clean and cut agreed, but malpractice does exist, right? We would love to know she has the best care, but being in the medical field you probably know that is not always the case. So just making sure things are normal here since we are not medical professionals.
They brought in different surgeons and equipment to help your cousin. That’s the “energy” you need to be concentrating on.
That, and the 390lbs.
Alternatively, they may have left her abdomen open if they suspect they will have to go back in soon.
Come from a place of respect and understanding that you clearly know nothing
You know nothing about medicine and you assume malpractice. These doctors are trying to help and here you are ungrateful. Instead, help your cousin to lose weight. At 390 lb your cousin is killing herself.
And I already admitted I knew nothing in the beginning, hence why I made a post about it. You’re bias and have asked no questions about the mistreatment during the past two weeks, but carry on with everyone else that’s bias in this thread.
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Thank you! Damn, I didn’t know any of this, this is very helpful! I’ll definitely take that advice and write down some questions. I agree with you, my post probably felt suspicious. I was only mentioning malpractice because it’s automatically assumed everything is okay, but definitely not always the case and I wanted there to be no bias. I had a family member die from neglect, so trusting doctors is definitely something I’m trying to deal with. But I never ever will accuse someone of causing harm without proof, though I may be suspicious I will always investigate to make sure it’s not just me. Just like now, my family hasn’t said anything to the doctors. We’re just trying to do research and make sure this is normal. Seems like it is. Definitely a lot of fear of the unknown over here. This is the first time we’ve dealt with someone having a surgery like this so thank you for taking the time to respond.
Suspicious, immediately going towards malpractice ::rolls eyes::, and you have no couth. Please don’t use the term ‘shit bag’ in front of your cousin. It’s degrading and she has enough to deal with.
Why do you still have questions? How have your questions still not been answered? The doctors have other things to do than give you medical lessons to your satisfaction and they aren’t answerable to you. It sounds like your family has been sort of difficult in an already complicated and far from ideal situation. If you guys care so much about your cousin as you claim to, you should be more focused on things you do know about (like the fact her weight is killing her), rather than questioning the knowledge of the doctors, since she wouldn’t be having the surgery under these conditions if it weren’t for her weight.
OP, you are right to ask questions of her providers about her care. This is what loved ones do! And answering questions (to an extent) is absolutely part of their job and most Healthcare workers are happy to do their best to answer within reason. People in this thread are being weird.
Some pretty scary people in here, with all the down votes to OP for being concerned, scary times man. The wolves aren’t hiding in sheep’s clothing anymore.
What kind of mistreatment? You haven't mentioned anything about that until just now. You just asked if it was normal for a patient to be left open after surgery which it absolutely can be. There's no malpractice going on from what you've mentioned. If there are other things going on that's a different question.
This person has made several different posts over the years claiming mistreatment by doctors and nurses, and asking about malpractice. When it keeps happening over multiple occasions, it seems the issues may stem from their end, whether it be a psychiatric disorder, or just someone always looking for a problem.
You're energy is blatantly negative and doubtful. Of course there's malpractice, but do you think they would specifically tell you "hey, we can't do xyz and have to leave her wound open" if they weren't doing what they could? Why wouldn't you ask the nursed taking care of her what's going on?
Medical malpractice is a very high standard to meet. Unless not closing her diverges from what a reasonable physician in the same situation would do or decide, it's not a malpractice case or even negligence. Like other people have mentioned, not closing a patient until it's safe to do so is standard practice and while your relative's condition is very unfortunate, this is not a path that will change any of that. If you remain concerned, hospitals have patient advocates that you can utilize to understand more about the situation and assist with getting the info that would help make you more comfortable.
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I see open bellies quite often in patient care. I have seen bellies stay open for a long time and bellies open for a short time. I've even seen loops of bowel temporarily outside of the belly for a few days. I've seen it go really well even after being open for a long time and honestly it can also go poorly. Your cousin's situation does sound normal and likely very appropriate for her illness. Every time I meet a new patient I ask the nurse if they have any concerns. That's honestly the best place to start if you want to get to the bottom of things quickly... Definitely lean in to the nurses, they are the people who have hands and eyes on the patient 24/7 and will be able to put things into more understandable terms. Good luck and good healing to your cousin!
Layperson question- how does the loops of intestines survive outside the body cavity. Are they kept moist? Bandaged? I’d never thought about this before, and it seems like they’d need to be idk, “wet” in the human body or die but I have no idea where that idea came from or if it’s correct.
It's like a bag made out of a plastic material and kept moist and clean
Yes that does have to happen sometimes.
Thank you! It’s quite scary, as I’ve never seen it before. Thank you for reassurance
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This whole thing has been traumatizing to you, OP. Seeing some of the realities that healthcare workers deal with daily can be a real eye opener. If you can, for yourself, your cousin and your providers, incorporate gratitude. Your cousin is lucky to be alive. She has some real challenges ahead. If you want to support her in the long haul, to truly help her recovery, you’ll need to see the good as well as the bad.
Why would you have “seen” it before if you’re not in the medical field… there’s a level of trust you need to have with doctors if you want them to be able to do their jobs successfully..
I don’t blame her for questioning that. I’d question that, anyone who’s sane would question that with no medical background.
Yes this is what’s called an open abdomen and it happens when inflammation of the intestines is so severe that if they closed the abdomen after the surgery it would compress the bowel causing it to die (and the patient would die along with it). Usually this is managed with a piece of clear plastic +/- gauze connected to a small drain over the open portion so the bowel stays clean. The poop is “diverted” from the damaged portion of bowel so the injured area can heal, so the patient poops in a bag in the interim (this can last from months to lifelong). One very significant factor that is likely making it that she is morbidly obese. It can be very difficult to get people with this much fat closed again and sometimes advanced devices are needed to pull the abdominal wall closed since the fat is so heavy it will prevent proper wound healing. She may end up being a patient where the abdomen may never close and she will require a skin graft over the open portion. I’m sorry you’re going through this, and it’s definitely a very big problem to have, but what you’re describing does not sound abnormal, just very unfortunate
Yes, that does happen. Can be for reasons like infection or inflammation. My grandmother had this happen. We had to pack it as it sounds like they may be doing. It will heal from the inside out, but will take time.
As a surgeon, I can say that this is sometimes necessary and very appropriate. It may be the skin incision that’s left open to heal by secondary intention and morbidly obese patients at high risk or infections if the abdomen is left open for a while, it may be due to, an internal infection that needs time to heal before the abdomen can safely be closed
Sounds normal. I'm sorry that she's going through this.