It's slowly starting to sink in that everything that is supposed to come out of his rectum is now exiting through the fistula and "vagina". The tear creates a passage from the rectum to the "vagina", and farts and poop come out, which is gross, but you have to factor in the anus -- the gatekeeper, if you will.
Various things are entering the rectum via the lower intestine, which might not be so bad if gas, mucus, fluids and solids could passively drain through the anus. The human anus isn't passive, though; it's made to keep the inside stuff inside, and it's tight enough that gas, at least, will take the path of least resistance and exit through the open fistula because the anus seals everything in the rectum so tightly and efficiently. Effectively, the strength of the anus makes his rectum a chamber with only one easy avenue of escape. Instead of a rectum/anus combination that keeps things contained, his lower intestine is now a portal directly to the outside world.
If he's taking stool softeners or (God forbid) has diarrhea, it'll extrude through the fistula like soft-serve and dribble out of his body through the completely slack and passive "vagina". If the poops are rough or hard, my guess is they would further open the fistula. The plan at the moment seems to be waiting for it to heal on its own, but it's hard to conceive how a fissure could ever heal under these circumstances.
Come to think of it, escape through the "vagina" may be the best possible outcome, because at least the waste will be exiting his body. As I understand it, a "tunnel" is carved between the bladder and the rectum, hopefully not too close to either, and an inverted flesh sock (made from the skin of the penis and/or scrotal/peritoneal skin) is installed in the tunnel. I guess the outer layer of the flesh sock is supposed to eventually fuse with the sides of the tunnel ... but until that happens, wouldn't there be sort of a pocket or gap? The gas would probably still go through the fistula and exit the body, but it's easy to see how anything solid or semi-liquid could end up trapped in that gap instead. If that's the case, how could there be any possible outcome but sepsis and death?
He has an open wound -- the raw inside of the carved tunnel -- and because of the fistula he may be depositing feces directly on it.
The fistula/hole has to be in the wall of his rectum because that's where the gas and feces that he's seeing originate. I've been thinking there was a corresponding hole in the sock/"vagina" too, and everything was passing into the "vagina"and out of the body. Is that how it works? Or is the "vagina" airtight and the gas and feces are filling the carved tunnel and escaping through the stitches?
Why in the hell would his SRS surgeon not be making a plan with him to fix this? I don't see it healing and we know that no other surgeon will likely help him.
If I've got my facts straight, it seems like a (hopefully) temporary colostomy bag, to prevent infection and further damage, followed by corrective surgery is his only hope of leading any kind of normal life.
Jesus Christ on a piece of toast. How horrible.
