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Gastroenterology (Expert Forum)
treatment of hematoma after removal of abdominal fistula
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
treatment of hematoma after removal of abdominal fistula
by 1robin, Nov 08, 2006 12:00AM
Hello
My family is currently statitoned in Wurzburg , Germany . On July 14 2006 my son, who is 15 years old had surgery to remove an ileus at a German hospital. He then developed an abscess a few days after his intial surgery. The abscess was drained and packed with guaze twice daily for aobut three weeks. Then once daily for about 4 weeks. Then once every third day. This went on for a total of 3mths after his intial surgery. On 09oct06 I inquired about the length of time it was taking to heal so they ordered an x-ray using dye. The xray showed there was a fistula about 8cm long and 4cm wide and surgery was needed to heal. My son had a second surgery on 23oct2006 to remove the fistula and everything was fine until about ten days after surgery when blood started draining from the wound( although the wound was very swollen and bruised after surgery the doctors said that was normal when I questioned them about it) the doctors examined the wound when I took my son in for bandage changing and removal of stitches.They determined without xray or sonogram that there was hematoma.The doctor explained that this was a normal complication of this type of surgery. That my son's weight and the fact that he has a lot of fatty tissue on his stomach attributed greatly to this complication.He said this was not life threatening but it had to be drained and packed with guaze everyday until the bleeding stopped. He explained that the fatty tissue could not be sewn together and that the veins in the tissue were bleeding. He said that eventually the tissue would grow together and heal but because there was so much fatty tissue it would take time.I'm afraid my son is slowly bleeding to death. Also there is conflict between doctors on how to treat the hematoma. One doctor says that the wound should be drained and not packed because they made that mistake with the abscess and that's why it wouldn't heal. The other doctor says that it should be packed with guaze to apply pressure to the vein to stop the bleeding. Is my son getting the proper treatment at this German hospital? I can get a referral hopefully to the states or the nearest american hospital in Germany, but I need to know did they give the right treament for the abscess as well as the hematoma he's been diagnosed with(was he even diagnosed correctly)???? Is surgery the best prognosis for my son who is morbidly obese or is this a factor.He's 288lbs and 6" tall.I appreciate your response to this question as soon as possible
My family is currently statitoned in Wurzburg , Germany . On July 14 2006 my son, who is 15 years old had surgery to remove an ileus at a German hospital. He then developed an abscess a few days after his intial surgery. The abscess was drained and packed with guaze twice daily for aobut three weeks. Then once daily for about 4 weeks. Then once every third day. This went on for a total of 3mths after his intial surgery. On 09oct06 I inquired about the length of time it was taking to heal so they ordered an x-ray using dye. The xray showed there was a fistula about 8cm long and 4cm wide and surgery was needed to heal. My son had a second surgery on 23oct2006 to remove the fistula and everything was fine until about ten days after surgery when blood started draining from the wound( although the wound was very swollen and bruised after surgery the doctors said that was normal when I questioned them about it) the doctors examined the wound when I took my son in for bandage changing and removal of stitches.They determined without xray or sonogram that there was hematoma.The doctor explained that this was a normal complication of this type of surgery. That my son's weight and the fact that he has a lot of fatty tissue on his stomach attributed greatly to this complication.He said this was not life threatening but it had to be drained and packed with guaze everyday until the bleeding stopped. He explained that the fatty tissue could not be sewn together and that the veins in the tissue were bleeding. He said that eventually the tissue would grow together and heal but because there was so much fatty tissue it would take time.I'm afraid my son is slowly bleeding to death. Also there is conflict between doctors on how to treat the hematoma. One doctor says that the wound should be drained and not packed because they made that mistake with the abscess and that's why it wouldn't heal. The other doctor says that it should be packed with guaze to apply pressure to the vein to stop the bleeding. Is my son getting the proper treatment at this German hospital? I can get a referral hopefully to the states or the nearest american hospital in Germany, but I need to know did they give the right treament for the abscess as well as the hematoma he's been diagnosed with(was he even diagnosed correctly)???? Is surgery the best prognosis for my son who is morbidly obese or is this a factor.He's 288lbs and 6" tall.I appreciate your response to this question as soon as possible
Doctor's Answer
by Kevin Pho, MD, Nov 09, 2006 12:00AM
, Nov 09, 2006 12:00AM
It is difficult to evaluated the correct course of treatment without evaluation. Obesity would make the surgery a higher risk. In cases where there is conflicting opinion as to what to do, obtaining more evaluations can be considered. This should preferably be done at an academic medical center, where they see more complex cases.
If there truly is in abscess, then it would need to be drained appropriately. As for the hematoma, it would depend on the severity and location - I cannot give a suggested course of treatment without evaluation.
Another consideration would be a referral to a plastic surgeon.
These questions should be discussed with your personal physician, or in conjunction with another surgical opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
If there truly is in abscess, then it would need to be drained appropriately. As for the hematoma, it would depend on the severity and location - I cannot give a suggested course of treatment without evaluation.
Another consideration would be a referral to a plastic surgeon.
These questions should be discussed with your personal physician, or in conjunction with another surgical opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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The fistula was only in the surface tissue, it did not reach the abdominal wall