Conservative management of a self-fashioned de-functioning colostomy in a patient with complex psychiatric comorbidities

Since 2004, the patient had received ongoing input from local mental health services regarding her childhood sexual abuse, emotional instability and maladaptive coping mechanisms of increased alcohol use and self-harming. Self-harm is a cause of up to 200 000 admissions to hospital each year in England, and concurrent psychiatric illness is a strong risk factor.1 Patients diagnosed with borderline personality disorder and post-traumatic stress disorder are associated with an increased risk of self-harm and suicide.2 Repetition of self-harm within the first year is reported to occur in approximately 16% of patients, with a higher risk of repetition seen in those with a greater number of psychiatric illnesses, including personality disorder.3 Therefore, early intervention of comorbid psychiatric illness in patients suffering self-harm injuries could reduce their recurrence, as illustrated in this case report. The success of a conservative management approach to a hostile abdomen where appropriate in allowing the chronic needs of a patient to be addressed, in this case reducing the risks of recurrent self-harm and potentially irreparable injuries in a patient with concurrent psychiatric illness.