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Hartmann's pouch complications...?

Posted by elli bean, on Tue Oct 26, 2010 6:26 pm
Wondering if anybody can help me here?
I have a loop colostomy right now, and in the near future am hoping to have it changed to an end one at the sigmoid with a Hartmann's pouch. Now I am a bit worried, and even though I do have an appointment with a surgeon to discuss the issues of concern, I've found in the past that doctors don't always tell you everything and what's more don't seem to know it half the time. So, I'm wondering if anybody knows if this is correct- according to several pubmed and Elsevier articles, the mortality rate for the Hartmann's procedure varies from 9 to 21%...and I can't say I'm at all comfortable with the possibility of dying at this point in my life. Supposedly the rate drops when the procedure is done by a colorectal surgeon but my colorectal surgeon only does laparotomies and he referred me to his associate when I said I would prefer it be done laparoscopically...but his associate is not a colorectal surgeon. He specializes in laparoscopy, bariatric surgery and does colonoscopies with biopsy. My appointment is with him and it's on Friday but now I'm a little unsure.
Other issue is, for people who have had this procedure, what exactly happens with the blind pouch that's left in there? In what way does it differ from what happens in a loop colostomy? I've heard things about it rupturing, or atrophying, or developing occult precancerous polyps which develop into cancer without being noticed since that bit of bowel hasn't got much of a job to do anymore aside from passing a bit of mucus. I really don't want to affect the condition of my rectum in any way, because I have had enough problems with it and even though I doubt I'll ever bother with it, I may be eligible for reversal. I would prefer that area to stay as it is, and have my ostomy moved from the transverse colon to a position where it can be better regulated and where it will not be so active and bags will last longer and interfere less with my clothes (no more huge balloons under my shirt covering half of my abdomen or dissolving wafers hopefully).
Fortunately ( I think?) I am 20, generally pretty healthy, and my ostomy is for benign disease, though I have always been mildly to severely anemic.

Also, I joined this site 5 or 6 months ago and have not been very social...I have posted a couple of questions and not a lot of answers or other content...I hope this is not interpreted as me being a leech who demands and does not contribute...I don't really know much about what a lot of people ask as I haven't been through as much as many of you, my issues were mostly just written off as me being a hypochondriac and no diagnosis or treatment offered for many years. I have also been busy and dead tired as I had a baby girl a couple of months back and am staying with my parents temporarily to get some health and financial issues squared away so I can take my daughter home and we can be with her daddy. Not excuses, just reasons. I hope no one takes offense.
Reply by gutenberg, on Tue Oct 26, 2010 8:16 pm
elli bean, sure wish I could help but I really don't know about any of the stuff you write about as I got my ileostomy literally overnight and knew nothing about what had happened to me for quite a while after the two operations I went through and that was all because of a mistake by a surgeon, so, keep asking your questions, surely someone can give you a few pointers, and good luck in your endeavors, Ed
Reply by Katman, on Wed Oct 27, 2010 12:28 pm
Hello Elli Bean,

Still recouping from my own colectomy and loop ileostomy... hoping to have it reversed at some point.  But while I am sitting around, I can at least do research!

The Hartmann Pouch is well described in the first two links below.  Essentially, you will be receiving a colostomy (not a loop, only one opening) at the sigmoid colon.  The remaining section, rather than opening through a stoma, is closed and left "hanging" internally until future reconnection.

The third link below lists the complications and mobidity study comparing a Hartmann Pouch with a loop ostomy... and summarizes that there is no appreciable increase in morbidity.  It is a bit more work, though, for the surgeon.


http://www.ostomates.org/ostomies.html
http://www.atlasofpelvicsurgery.com/7Colon/3EndSigmoidColostomyWithHartmannsPouch/chap7sec3.html
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHS-4BX2B2X-45&_user=10&_coverDate=12%2F31%2F1991&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1516417675&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=61adb3a8e4e565005eb505dc14a302a5&searchtype=a

Hope this helps...

Katman
Reply by Pinky, on Wed Oct 27, 2010 3:22 pm
Hi Elli Bean - I'm glad you are back - and I think having a baby exonerates you from posting on this site for a while!  I for one DO NOT think you are anything but an extremely brave young lady dealing with a very difficult situation.

I think I may have had the equivalent of a Hartmann pouch back in 2003 but did not realize it.  I had had a loop colostomy which gave me no end of problems, including an horrible proplapse that had to be "put back in" in the ER.

Then the second temp (sigmoid) colostomy was a dream for 7 months.  Then I had a reversal, OK for 2 years, then about 3 years of pain and problems in the rectum.  Lots of  tests all along the way to see why I had so much pain, drugs, accidents, etc. and to check for any cancer recurrences.

Now I have a permanent descending colostomy, with a rectal stump.  My surgeon gives me the lovely digital rectal exam every 3-6 months and an MRI about once a year.  When I have flare-ups in my rectum due to radiation proctitis, I use steroidal suppositories to calm down the inflammation.  

Good luck, sweetie!    Smile
Reply by junopete, on Fri Oct 29, 2010 12:56 am
ELLI

I strongly recommend not doing the procedure laproscopecly.

If you are to have it done, have it done open.

Also don't screw around with second rate surgeons.  Get the absolute best in the business.
I mean the best.  If you have to go out of town then do it.  Research it well.

Good luck

Rick.....
Reply by Snowwhite, on Sun Oct 31, 2010 10:22 pm
Hi. I do not have the same questions or issues as you....I have my own.  Besides that, we both have ostomies. If you ever want to talk on the phone (anytime.....I don't sleep cause I have to empty this pouch so often ), meet, or just e mail, leave me your e mail and I will contact you. Hope thing work out one way or another.

Zerlina
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