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Gastroenterology (Expert Forum)
Life after a total colectomy...
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
Life after a total colectomy...
by Morecambe, Nov 25, 2004 12:00AM
Good day from England. About a year ago I suffered massive rectal bleeding and required transfusion of about 16 pints of blood over 3-4 days as well as the usual saline/glucose IV drips. Quite a melodrama!! After a colonoscopy, widespread diverticular disease was diagnosed and my surgeon advised a total colectomy which was performed last March (2004). I was fortunate not to require a colostomy bag etc and, in general, have recovered well over the last 6-7 months. My bowel motions (4-6 per day) are of "muddy/sludgy/semi-diarrhoea (sorry about the English spelling!!) consistency". Recently I have suffered occasional mild-constipation and this has prompted me to become concerned about the longevity of the surgical procedure. Please could I pose to you the following questions:-
a) how strong is the join (anastomosis??) between the end of the small bowel and the rectum? Do the two ends "heal together" (like a cut) or is the strength of the join only as good as the quality and integrity of the surgical stitching? Is there any risk of rupture/splitting at the site of the join leading to peritonitis or whatever - especially if the join is subjected to pressure from constipation?
b) what would happen if the rectal bleeding starts again - but in this case from the small bowel? Can a colonoscopy be performed into the small bowel or is this structure too delicate for the insertion of a colonoscope?
c) sometimes I notice that my bowel motions seem to have a very slight red tint - but without any free blood. Is it possible that, in view of the colon-shortened bowel length, the colouring from foods such as tomato soup, strawberries etc would impart this red tint to my bowel motions?
d) in case of further bleeding from the small intestines, can sections of the small bowel be removed after a total colectomy or would this leave the intestines too depleted?
e) are there any long term effects to be anticipated from "life without a colon"?
Many thanks in anticipation of your reply.
Best regards
a) how strong is the join (anastomosis??) between the end of the small bowel and the rectum? Do the two ends "heal together" (like a cut) or is the strength of the join only as good as the quality and integrity of the surgical stitching? Is there any risk of rupture/splitting at the site of the join leading to peritonitis or whatever - especially if the join is subjected to pressure from constipation?
b) what would happen if the rectal bleeding starts again - but in this case from the small bowel? Can a colonoscopy be performed into the small bowel or is this structure too delicate for the insertion of a colonoscope?
c) sometimes I notice that my bowel motions seem to have a very slight red tint - but without any free blood. Is it possible that, in view of the colon-shortened bowel length, the colouring from foods such as tomato soup, strawberries etc would impart this red tint to my bowel motions?
d) in case of further bleeding from the small intestines, can sections of the small bowel be removed after a total colectomy or would this leave the intestines too depleted?
e) are there any long term effects to be anticipated from "life without a colon"?
Many thanks in anticipation of your reply.
Best regards
Doctor's Answer
by Kevin Pho, MD, Nov 29, 2004 12:00AM
, Nov 29, 2004 12:00AM
These questions were answered in the comments below and I've reviewed and agree with the answers. I'll reprint them here as comments are not saved:
"a) the "join" heals completely, and within weeks its strength has nothing to do with the sutures. It's at least as strong as, if not stronger than, any area of your intestine. Rupture of the suture line after the first couple of weeks is virtually impossible.
b) it's possible to get a scope in a short way. Nowadays there are other tests to locate bleeding in the small bowel, including a very small camera that's swallowed and which transmits pictures. However, having had bleeding diverticula of the colon really has no relation to risk of small bowel bleeding, which is in fact quite rare, comparatively speaking.
c) quite possible.
d) quite a large portion of the small intestine can be removed with little or no consequence, except for the very most distant portion. Once again, your risk of requiring such a procedure is not increased by having had colon diverticula.
e) none other than what you've already seen: more frequent bowel movements, and a tendency toward diarrhea. Nutrients from your diet are entirely absorbed in the small intestine, so nutrition is not really affected, other than the possibility of problems with fluids and electrolytes (salts in the blood) if diarrhea is not controlled."
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
"a) the "join" heals completely, and within weeks its strength has nothing to do with the sutures. It's at least as strong as, if not stronger than, any area of your intestine. Rupture of the suture line after the first couple of weeks is virtually impossible.
b) it's possible to get a scope in a short way. Nowadays there are other tests to locate bleeding in the small bowel, including a very small camera that's swallowed and which transmits pictures. However, having had bleeding diverticula of the colon really has no relation to risk of small bowel bleeding, which is in fact quite rare, comparatively speaking.
c) quite possible.
d) quite a large portion of the small intestine can be removed with little or no consequence, except for the very most distant portion. Once again, your risk of requiring such a procedure is not increased by having had colon diverticula.
e) none other than what you've already seen: more frequent bowel movements, and a tendency toward diarrhea. Nutrients from your diet are entirely absorbed in the small intestine, so nutrition is not really affected, other than the possibility of problems with fluids and electrolytes (salts in the blood) if diarrhea is not controlled."
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
b) it's possible to get a scope in a short way. Nowadays there are other tests to locate bleeding in the small bowel, including a very small camera that's swallowed and which transmits pictures. However, having had bleeding diverticula of the colon really has no relation to risk of small bowel bleeding, which is in fact quite rare, comparatively speaking.
c) quite possible.
,
d) quite a large portion of the small intestine can be removed with little or no consequence, except for the very most distant portion. Once again, your risk of requiring such a procedure is not increased by having had colon diverticula.
e) none other than what you've already seen: more frequent bowel movements, and a tendency toward diarrhea. Nutrients from your diet are entirely absorbed in the small intestine, so nutrition is not really affected, other than the possibility of problems with fluids and electrolytes (salts in the blood) if diarrhea is not controlled.