Removal of 15 inches of small bowell

[Ms. G]

Im a 78 yr old female. good health generally. About 20 years ago, I had a loop of small bowell trapped under an adhesion. Gangrene developed and I lost about 15 inches of small bowell. Since then I have had diarrhea, burning anally, and associated itching (almost like hives) with the diarrhea.  I have used Questran often to stop the diarrhea. Now, it seems like I HAVE to use Questran all the time.(Im using 1/4 dose-cup size.) Treating physicians (I have a gastro specialist) have assumed that the reason I have the diarrhea is bile released into the colon due to not enough small intestine. Im concerned that there may be something else in play here other than the small bowell situation.(like the itching.) What other tests can I suggest to him to perform so I can rule out any other problem like liver or bile duct problem? I dont want this Questran to mask a real problem. I can take it all the time if I have to for the rest of my life, but want your comments

[Kevin Pho, MD]

Surgeon has kindly addrssed your question 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.

[chrisj2641]

Luckless...Thanks for the info. They removed mine from the ilium but not the valve. I have to verify that with the Gastro. I'll also ask about the B12. I have been keeping a spead sheet on bowel monements [weird huh?] and I do see improvement. Its ironic that the spead sheet works. I get so discussed with this desease that I tend to be negative. By seeing things in writing I get the facts and nothing but the facts. It also helps the Gastro because my mind is some what useless anymore [59 years old]. So I just show him all the information. I'll also have to ask him if the Questran is expected to be a permanent part of my life. I also take Pentasa and Rowasa enyma's [don't like them].

[surgeon]

yes, that's the part I was referring to: the most distal small bowel, which is involved in absorption of many things including bile salts. It's still true, however, that most people have enough of that portion of the bowel to get along ok with 15" removed; so anatomic issues such as narrowing are still of concern. I'd think the imaging I mentioned is still worth considering. It may well be that you are among the small number who will need continual treatment, such as daily questran. It also may help to find a daily dose of immodium that would help; it's a lot cheaper than questran. Some people find they need both, however.

[Ms. G]

I talked to my Gastro guy today.He communicates well...calls back...and tells me to call him. Communication - wise....he's the best. He says that it seems like the liver, pancreas, etc are working good...putting out bile, etc.I have no pain, no nausea..He says..--Its the surgery that keeps me from absorbing. I also itch alot when I have the diarrhea. He says thats the failure to absorb the bile. He states that the fact that the Questran is working so well, with only a 1/4 regular dose means that its the surgery (the amount of small bowell removed)....that was the cause, not a faulty liver, pancreas, etc. I dont have the big D anymore, GERD is better, itching gone, appitite good, gas better (and Im beginnig to get off the bland diet he put me on for one week.)Any comments?
Thanks to all...This is great for us lay people

[chrisj2641]

I had 18 to 24 inches of my small intestine removed in August. I have been on Questran ever since. 2 or 3 pouches a day. I have to take an Immodium every couple days. I still have 4 to 5 bowel movements a day. Most of the time I'm not running though. Itching is a problem also. The Questran seems to help that. I also have some anal burning but nothing I can't live with. Atleast the Questran keeps your cholestrol low. Mine was 162 last time it was checked. I really expected more out of the operation. I thought I come out "normal". I can't say the surgery was a failure because the pain and discomfort are gone but the I expected more in the bowel movement area.
So goes life.

[yoshi]

not to replace flora,but to restore good flora.
you mention gangrene and surgery and then diarhea and itching etc,so i thought you may be taking antibiotics.
good yogurt with that acidphil bacteria (check the whole word spelling) would restore the good bacteria destroyed by anti biotics or there are pills which such bacteria you can find in health food store or pharmacy.
you can read more about flora and acidphil---- bacteria if you just search on internet or talk to anyone in a health food store.

[Ms. G]

They took out 12 - 15 inches of the small bowell ..near the cecum....I found out. Does that make a difference????
Thanks

[Ms. G]

Thanks Chris
Let me ask....what part of the small bowell was removed, can you find out. Was it the last part(close to the big colon) or toward the beginning of the small bowell....where the stomach empties into it???
What have they told you about Questran?? Do you have to stay on it indefinately??
Thanks alot!!!

[luckless]

Chris
I had a small bowel resection 2 years ago where they removed 2 foot of small bowel and the ilieal valve removed. The doctor told me to expect diarrhea for several months because the intestine is used to forcing the stool through a part of bowel that was somewhat obstructed before. So hang in there. Also make sure that they monitor your B12 levels because this is the part of the intestine in which it is absorbed. You could be at risk for malabsoption. Which if needed can be repalaced with injections. B12 is necessary for the poduction of red blood cells. Hope this helps

[yoshi]

are you taking something to restore the flora in your system?/

[Ms. G]

Thanks!!
Is there a liver test , bile duct test or pancreatic test to see why so much bile is getting into the intestine and causing the big D. The fact that Questran works...does that indicate that its really "bile" and not regular stomach acid? I have a good appitite, regular movements when I dont have the Big D.
Thanks you sooooo much

[surgeon]

Losing 15 inches of small bowel rarely would cause the problems you describe; in fact, if it were in any part but the very last portion of the small bowel, it ought to have no side effects at all. If the very last portion, including the "valve" between the small and large bowel, were removed, it's possible to be related. It would be interesting to know if the operative report from then were available. It's also possible to have narrowing of the area where the ends of the bowel were sewn together, which could cause problems such as yours. I'd think in terms of a small bowel study -- contrast material taken by mouth and followed thru, either with regular xrays or CT scan; and also colonoscopy to rule out several colon problems that could be involved as well.

[Ms. G]

NO Im not. I just began taking this Questran again..Ive taken it before.... and it miraculously stopped the diarrhea. Im just worried about taking it all the time. What is good to replace the flora??When I have the Big D, the movement is water like...burns the anal area....and I "go" about 6 times a day..sometime associated with GERD...BUt this Questran has stopped it.Thanks !!!!