Bleeding in the Colon

[Wrigley]

My friend Tom was diagnosed last year with bladder cancer.  He had his bladder removed and received chemotherapy.  A couple of months ago two tumors appeared in his pelvis area.  At this time he also had a blood clot in his left leg in which they gave him Coumadin. He has since then undergone 25 radiation treatments to shrink the tumors in his pelvis. He has had bleeding from his retum twice.  Once before the radiation (after the Coumadin) and now currently.  The first incident required him receiving 11 units of blood.  As of today (during the second incident) he has received an additional 6 units of blood.  The current diagnosis is viral gastroenteritis with bleeding in his cecum.  

The gastroenterologist can not pin point the bleeding to cauterize it. At this point they want to do expoloratory surgery in which they will remove the part of the intestines where the bleeding is occuring.

  My friend does not want to have this surgery because the physician said there would be a possibility of him having to have a colostomy bag.  (he already has a bag from his bladder removal) Would this be standard procedure?  Do you know the likelyhood of him requiring a colostomy bag?  Do you know of any alternative treatments?  Please share any and all information you have regarding this circumstance.  

Tom is 45 years old, with a wife and a seven year old daughter.  Unfortunately he has been given a death sentence by the parade of physicians he has visited.  Therefore, we have lost confidence in the local medical professionals (South Florida including Tampa) and are seeking help in other areas of the country.  If you have any information on treatment programs anywhere in the country that could be of assistance I would also appreciate that information.

Obviously we are very desperate at this situation and welcome any help.

[Kevin Pho, MD]

As for another opinion - it would never hurt to go to a major academic medical center (normally affiliated with a large university).  

Regarding the bleeding - if the GI doc can't find the source (i.e. via a colonoscopy), then unfortunately surgery would then be considered.  A bleeding scan can be done to further evaluate the source of the bleed.  

If a colectomy is required to treat the bleeding, then a colostomy bag would be necessary.  However, this is normally temorary, and can be reversed as the colon heals from the surgery.

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.
Medical Weblog:
kevinmd_b

[surgeon]

It's actually not true that a colostomy would be automatically necessary if colon resection were done for bleeding. In fact, in most cases, it would not be needed, unless the patient were in very unstable condition at the time of the surgery. But most operations for colon bleeding are done having had the time to stabilize the patient; and since blood is a great laxative, the colon is usually well enough prepared safely to sew it back to together. There's judgement involved, of course, and the need for colostomy can't be ruled out with certainty. It can also depend on how certain it is that the source of bleeding has been taken care of by the surgery; when there's no clue where in the colon is the source, essentially the whole colon has to be removed. But it's rarely necessary to take it deep into the pelvis, so there's enough left to sew to the small intestine; and such a hookup is considered safe to do under most circumstances, even urgent ones most of the time.