Any suggestions?

Question

Two years ago I had a small bowel resection and total hystectomy for endo. Post op wound infection and dehis. Followed by C diff.(resolved). Last oct. was a bout of undetermied colitis (ulcers throught the entire colon) treated with pentasa and steroids. Reqired two incisional hernia repairs with mesh. One confirmed episode of diverticulitis. Still suffering with bouts of RLQ pain and diarrhea,urgency. Can not tolerate any fruits of veggies, they cause pain and diarrhea. Seen in the ER on Sunday for severe colicy abd pain (RLQ) and watery diarrhea after eating. Doc said that the AXR looked like patial obstruction by gas pattern. See by GI on Tues. Had another xray (Radiologist read as normal gas pattern) CT done of Thursday interpted as no acute changes. Labs normal except sed rate of 21. Treated with Cipro and alittle better now. Could not eat solids for 10 days. Mesinteric angio in Dec normal
Last colonoscopy in may normal. SBFT in may showed adhesions around the area of the anastomosis but the radiologist was able to open it my inserting air rectally.  Is it possible for a partial bowel obstuction to go away without leaving changes on the CT? Can endometriosis reoccur after hysterectomy? Can a dianostic lap be performed with the mesh in place? Could food be causing intermittant obstruction or ischemia?

surgeon · Answer

whatever the radiologist did, it would not have "cured" the problem. I'd suggest seeing a surgeon for an opinion about re-operation.

luckless · Answer

Do you have any suggestions to what I can do now? I can not bear the thought of going through another bout of pain and diarrhea. Is there any other tests I should have done? My last SBFT was in May and after the radiologist found the adhesions near the anastomosis he was able to open them by inserting air rectally. Does this mean that the these loops of bowel adhered together are not the source of all my discomfort? It feels as though things are not passing through and then when the stool finally gets through the force is so great that I get watery stools. I am to the point that I am afraid to eat

Kevin Pho MD · Answer

Surgeon has kindly addressed your questions in his comments below and I agree with his assessment.  

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. 

Thanks, 
Kevin, M.D.

luckless · Answer

What can be done to prevent the reoccurance of the bowel obstructions? What causes the colitis to come and go like that?

surgeon · Answer

bowel obstructions can occur intermittantly, and when asymptomatic, have no findings on xray. Laparoscopy may be possible through the mesh, but likely it wouldn't be preferred by your surgeon. Once the uterus is gone, the source of endometriosis is gone. If you still have ovaries, and are premenopausal, endometriomas that remained after the surgery could still cause symptoms. Food is not likely the cause of obstructions, although if there were a chronic narrow area, high fiber foods could get stuck. Ischemia is not caused by food. If you had a narrowed blood vessel to the gut, you can have "intestinal angina" which is ischemia of the gut, and is exacerbated by the increased demand of digesting a meal.

surgeon · Answer

Prevention of bowel obstruction in generally isn't really possible, depending on the cause. If it's due to adhesions from prior surgery, if they occur often enough, one needs to consider surgical cutting of the adhesions; it has a good chance of working  (if that's the cause), however surgery can cause more adhesions. The idea is that most people who've had surgery get adhesions, but most don't cause trouble. So if new ones form, hopefully they'll be in places that don't cause more trouble. It sounds like the exact nature of your prior "colitis" is not entirely clear, which makes explaining its recurrances difficult.

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