Cramping after a colectomy

[mtacadena]

My son (now 15) was diagnosed with Ulcerative Colitis in 2010.  After 2 years of taking various meds (which did not work), he had a colectomy (on Aug 1).  18 days post-op, my son continues to have cramping daily.  Some days are worse than others.  His GI did a endoscopy on him 4 days ago to make sure that his small intestine was fine; he found nothing wrong.  He's been trying to stick to a low residue diet as well as avoiding gas causing foods (although it's been a challenge finding foods he CAN eat).  Can anyone offer advice?  

[ng1031]

Just wanted to update everyone incase they experience the same thing. The reason I was experiencing so much cramping was actually NOT normal and was a sign of a very serious blockage.

On February 26, 2013 I was rushed to my local ER because of course I could not go back to Mayo in MN. After weeks of cramping my bowel movements started to slow down drastically. Each time I was concerned I would contact my surgeon at Mayo who would refer me to his nurse who would call me and tell me this was normal. Before I knew it I had not gone in 3 days and was feeling worse so I contacted my motility specialist at Mayo who instructed me to go to my local ER. I am glad that I did. The ileus blockage at the anastomosis came back with a vengenous. The doctors told me that the first blockage I got may have been due to the flopped over section of the small intestine blocking my rectum however the twist did not "form". The twist was the way my small bowl was when the surgeons connected it to my rectum. When they cleared the blockage the twist was still there and opened up but it formed a crease where it was flopped over. So now my body was trying to heal the crease and in the process was closing up that area of the connection. It was to the point they could not open me up with a decompression tube like last time because it was pretty much healed shut with only 2 cm if that to spare. Another surgery was the only way to fix it. The surgeon at my local hospital went in to do laproscopic but ended up having to do "open" surgery to be able to see and fix things correctly. He removed the healed up/closed shut anastomosis connection. He then created a new one that flows with my body and has a larger diameter. The small bowel no longer twists as it connects to the rectum. It not flows with the curvature correctly to allow bowel to flow the way it is suppose to.

[ng1031]

I had a laparoscopic colectomy with ileorectal anastomosis surgery at the Mayo Clinic on January 18th for slow transit constipation. I was suppose to be in the hospital for 1 week and ended up there for 3 weeks. I formed an ileus.. the most pain I have ever felt in my entire life. I was on decompression tubes.. one in my nose/throat to my stomach and the other inserted in my rectum through the small intestine until my body could do things on it's own. Before the tubes I was vomiting bile. I was on morphine drip and it still was not enough for the pain. It has been aweful. Now I am home and no more narcotics.. just tylenol which to me does nothing but I understand that the narcotics are not good on the stomach. Did anyone else form an ileus? The surgeon told me that it happens to 10% of people and that the type I had was very rare. He also scared me when he said there was no guarantee it would not come back later on.

I also formed a blood clot in my liver so now I am giving myself Lovenox shots in the stomac every morning. I go to a doctor on March 9th to start coumadin pills. Because of this I had to stop my birth control. They believe it could have contributed to why I got the blood clot during surgery.

I am going more frequently (which is great from never going at all or feeling like your being ripped apart when you go) but because I am still on the liquid diet the bm's are also liquid. From hearing other people's stories I am surprised I do not got a million times a day. How much I go is pretty tolerable. I am behind as far as food.. I should be on week 4 introducing foods etc but instead I am only a week into things. The doctor sortof started me over after the ileus cleared so I am still on liquid/soft food.

Now its a matter of trying to deal with the aches and pains and these cramps whenever my bowls decide to move. Did anyone else experience these cramps? They are aweful. The doctors say its the small intestine trying to figure out what to do and that if it's making noises and moving that is a good sign that they are still working. It might be a good sign but its painful and keeps me up at night. I also getting a shooting pain whenever I pass anything that is not liquidy.. like if my bowl has any bit of substance to it I get this shooting pain in my lower right abdomen. Anyone experience this? Doctors say its because my body is healing. It just makes me nervous as I really am scared of the ileus returning. They told me as long as I am not vomiting again, passing gas/bm and do not have a fever that I am ok.

Just curious if anyone else experienced anything similiar?

[mtacadena]

Thank you very much.  I will discuss further with his GI specialist.  

[Christopher R Watters, MD]

If hevhas been diverted upstream (the ostomy), the cramping should be coming from small bowel. I'm confused as to why he would have done an endoscopy. The most likely diagnosis is portions of the small intestine adhering within the pelvis. This would be fairly typical and may take weeks to months to settle down. If there was a thought to further evaluate it this early a contrast study would be more appropriate than an endoscopy. The question is whether he has developed partial obstruction from the adhesions. A small bowel series would be the test of choice.

[mtacadena]

Hello Doctor.  My son had a total colectomy and now wears an ostomy bag - not sure what other information (re: his operation) I can provide.  His surgeon died 4 days after his surgery which was so disheartening.  We are looking for another surgeon.  His GI specialist thought it was concerning that he was having so much cramping still (now 20 days out)... so he performed an endoscopy last Thursday.  He said the endoscopy showed nothing wrong.  He suggested trying over the counter Imodium and Prilosec... neither has helped much.  

[Christopher R Watters, MD]

You have not said what operation he had. He's not even out three weeks yet - what does his surgeon say? It would be very early for GI function to be antwhere near normal assuming he had a total colectomy with a ileoanal pull through.