Post Op total Colectomy

[ABV]

Total colectomy May 4 for bleeding diverticulosis.  subsequent overproduction of acid. 30 cm. of colon was left to anastomose to the small intestine.  Esophogosgopy revealed Barrett's esophagos. At this time my husb. is having 3-4 liquid stools/daily....appetite is very poor and has lost 30 lbs and is very weak.  He is drinking liquids, electrolyte enriched to maintain hydration, but cannot seem to find any energy to do even the most minimal of personal hygiene tasks by himself.  He has been prescribed Metalase 'tonic' and Nexium and does rely on immodium for excess liquid stools. He sleeps well, but I sense labored breathing, very heavy.  He was 182 lb (6'1") before surg. and now is 159.  complains of abdominal discomfort and having a sensation of being full after two bites of food.  I take him outside for a daily walk (10 min x3 a day (under protest), but feel that the exercise is a must even if it is slow and easy. I see him getting weaker as the days go by instead of stronger.....we were told to expect a 4-6 month recovery period, but he is so weak it worries me.  We are in constant touch with his physician.  Thank you, ABV

[Kevin Pho, MD]

Hello - thanks for asking your question.

Our surgical colleague on the board is more qualified to answer this question and I would be interested in his comments.  

Any surgical procedure that disturbs the continuity of the intestine can lead to poor absorption of water and nutrients.  This can lead to increased amounts of diarrhea.  A variety of foods have been associated with increased stool frequency which include: apple juice, raw fruits, raw vegetables, popcorn, seeds, nuts, beans, corn, beer, caffeine, chocolate, milk & milk products and spicy foods.

A medication review should be performed since many medications can exacerbate diarrhea.  In addition to Immodium, bulking agents such as psyllium (Metamucil) and bile acid binders such as cholestyramine (Questran) can also be tried.  

Make sure that the more basic causes of fatigue is evaluated as well, including a blood count, metabolic panel, TSH, and liver function tests.  

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.

[surgeon]

It's hard to give very meaningful opinion without a lot more information. But whereas it can take a long time fully to recover from what he's been through, I'd say that there may be something going on still undiscovered; because most people would be further along by now. It's possible he has a partial blockage of his intestine, due either to adhesions or narrowing of the suture line where the small and large intestine were sewn together: that could cause persisiting diarrhea as well as a feeling of fullness. A contrast xray, such as a CT scan with contrast taken from above and from below might help to rule those out. Also, some sort of abscess from the surgery could cause his symptoms; not everyone with a post-op infection has high fevers. And, as Dr. Pho said, a complete blood workup is in order as well. If it were my patient, I'd be ordering a CT scan, and telling the radiologist to pay special attention to the anastomosis (suture line in the bowel), as well as looking for obstruction elsewhere, and an abscess. You said you are in touch with his doctors carefully, which is very important. It ought to include a gastroenterologist, especially if the above "surgical" issues are ruled out.