A Chronic Schizophrenia Patient who Pulled His Stoma and Needed Emergency Surgery

Abstract

A 76-year-old man with schizophrenia hospitalized in a psychiatric hospital for many years presented with stomachache. Abdominal CT showed colonic obstruction, findings consistent with sigmoid colon cancer and multiple liver metastases, and he was referred to our hospital. We tried to insert a long transanal tube, but misinsertion of the guidewire caused colonic perforation, and we scheduled emergency surgery. However, the patient refused operation, and we administered conservative medical treatment. About 10 days later, he suddenly said he wanted receive surgery, so we performed a transverse colostomy. Two days after the surgery, he pulled the stoma, which resulted in stomal prolapse of the transverse colon with the mesentery. We performed emergency surgery and reconstruction of the colostomy. At our hospital, while we pay attention to the special postoperative care needed for patients with psychiatric disorders, we had not considered self-removal of colostomy. Thus, in the postoperative care of patients with psychiatric disorders, possible self-removal of a colostomy by the patient should also be borne in mind.