Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.
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Subject: Re: Colorectal Surgery I need to ask your opinion on something. My mum was diagnosed as having pseudo-membraneous colitis that caused toxin megacolon in April 1997. Following severe diarrhea that came and went since December 1996. She was operated on and an ileostomy was done. She had the stoma bag for about 8 months after which she had it reversed following the Hartman's procedure(done 15/12/97) succesfully. However since she was disharged she repeated had abdoman pains that came and wetn but existed throughout the day. So far since she was discharged on 6/2/98, she was hospitalised on 17/2/98, 24/2/98 and 24/3/98 for severe abdomen pain and vommiting. She was also diagnosed as having Urinary tract Infection. However her colorectal surgeon came to the conclusion recently that her intestines are twisted or there is blockage of some kind. He is telling us that he is avoiding to do surgery because of her weakness(a couple of surgeries within 9 months) and old age(she is 56). My mum however has no other medical problems aside from this. He also mentioned that surgery of this nature like before causes adhesions that causes such complications. It is a double edged sword. I need to ask you; 1) What are the chances of her having a succesful surgery this time? What are the chances of her intestines will being twisted again? 2) What are the percentage of succesful surgeries of this nature? 3) What are the alternatives to surgery? Is there other form of treatments? 4) Is it advisable for her to go for another surgery? 5) Will having a colostomy bag again solve the problem?
From your description it is clear that your mother has had tough time over the past year. Although pseudomembranous colitis caused by Clostridium difficile infection is often easily treated with antibiotics, as you pointed out it can sometimes lead to toxic megacolon requiring colectomy. You implied that after the first operation (the ileostomy) she was doing well and that once the Hartman's procedure (ileostomy reversal and reconnection to rectal pouch) was performed she began to have difficulties with abdominal pain and vomiting. Adhesions (scar tissue) forming after abdominal operations are quite common but it is difficult to predict who will develop a mechanical obstruction after surgery. Although twisting of the intestine and blockage are a likely cause for her current symptoms, it would be better to document a specific point of obstruction with contrast x-rays of the intestinal tract prior to considering another major abdominal operation. As you mentioned, your mother did have a urinary tract infection during her last admission which could have also accounted for vomiting and abdominal pain. Other tests such as a CT scan of the abdomen may be required to exclude a variety of other causes of abdominal pain and vomiting prior to rushing to surgery. Nevertheless, after having said all that, if her symptoms persist, you may want to again discuss the option of recreating the ileostomy with her colorectal surgeon. It sounds like she would probably be stable enough to undergo another operation if all other options fail to help her. Prior to considering any operation it is important to carefully consider the risks and benefits of surgery. Good luck with this difficult problem. I hope you find this information helpful. This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health. If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology. HFHSM.D.-ym ______ ______
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