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Gastroenterology (Expert Forum)
Treatment after colon surgery
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.
Treatment after colon surgery
by angelmimi, Apr 09, 2003 12:00AM
This question is regarding my husband..I am very concerned.
A small maglignant tumor was found during a routine colonoscopy.
The gastroenterologist referred us immediately to a general surgeon, who performed a colon resection 4 days later...during the colon resection, the surgeon noticed a large amount of adhesions in the area of a prior appendectomy surgery and attempted to clean up the adhesions. The report was that less than 2 feet of the colon was removed, all the cancer was removed and my husband is cancer free...however after two weeks and various attempts my husband had not had bowel activity...it was determined that there was a blockage in the area on the small intestine..another surgery was perfomed and less than 2 feet of the small intestine was removed. After one week he was released from the hospital..on the first night home there was an excessive amount of drainage and he returned to the emergency room, now he had a fistula draining from the surgery site to the lower part of the incision...the drainage was feces..in a few days the upper part on the incision opened and started draining
yellowish green pus...he stayed in the hospital another week and was sent home with the instructions to use an ostomy bag to collect the drainage...there was so much drainage that 4 sites were open and we were using 4 bags...the fistula opening closed..but still excessive amounts of drainage from the other openings...sometimes one will close and another will open (all along the surgical line) Our family doctor told us that the surgeon would be the one to handle my husband's problems..the surgeon does see him and clean out the wound in his office (large amounts of mucus and large solid looking globs) During all this my husband has excessive diarrhea and has lost over 35 pounds..
he seems to be getting weaker...the surgeon has had two scans of the abcess (abscess) area and is taking a wait and see position...he says that he may need to open the incision and clean out the area...
he finally put him on antibiotic at my request...during the last scan a small deep vein trombosis was discoved..so we were sent back to the family doctor for that treatment...this doctor seems overly busy and preoccupied...I guess my question is...What kind of clinic or Doctor could help us at this time...we are afraid that we are not seeking out the right medical help. He needs treatment for the diarrhea, the abcess (abscess) , the blood clot,etc.
My husband is 74 years old and prior to the colonoscopy appeared to be in excellent health. He exercised and still had a full time job. The first surgery was over two months ago...
A small maglignant tumor was found during a routine colonoscopy.
The gastroenterologist referred us immediately to a general surgeon, who performed a colon resection 4 days later...during the colon resection, the surgeon noticed a large amount of adhesions in the area of a prior appendectomy surgery and attempted to clean up the adhesions. The report was that less than 2 feet of the colon was removed, all the cancer was removed and my husband is cancer free...however after two weeks and various attempts my husband had not had bowel activity...it was determined that there was a blockage in the area on the small intestine..another surgery was perfomed and less than 2 feet of the small intestine was removed. After one week he was released from the hospital..on the first night home there was an excessive amount of drainage and he returned to the emergency room, now he had a fistula draining from the surgery site to the lower part of the incision...the drainage was feces..in a few days the upper part on the incision opened and started draining
yellowish green pus...he stayed in the hospital another week and was sent home with the instructions to use an ostomy bag to collect the drainage...there was so much drainage that 4 sites were open and we were using 4 bags...the fistula opening closed..but still excessive amounts of drainage from the other openings...sometimes one will close and another will open (all along the surgical line) Our family doctor told us that the surgeon would be the one to handle my husband's problems..the surgeon does see him and clean out the wound in his office (large amounts of mucus and large solid looking globs) During all this my husband has excessive diarrhea and has lost over 35 pounds..
he seems to be getting weaker...the surgeon has had two scans of the abcess (abscess) area and is taking a wait and see position...he says that he may need to open the incision and clean out the area...
he finally put him on antibiotic at my request...during the last scan a small deep vein trombosis was discoved..so we were sent back to the family doctor for that treatment...this doctor seems overly busy and preoccupied...I guess my question is...What kind of clinic or Doctor could help us at this time...we are afraid that we are not seeking out the right medical help. He needs treatment for the diarrhea, the abcess (abscess) , the blood clot,etc.
My husband is 74 years old and prior to the colonoscopy appeared to be in excellent health. He exercised and still had a full time job. The first surgery was over two months ago...
Doctor's Answer
by Kevin Pho, MD, Apr 10, 2003 12:00AM
, Apr 10, 2003 12:00AM
Hello - thanks for asking your question.
You are describing an abdominal abscess, multiple surgeries for colon cancer and subsequent complications (adhesions), diarrhea, and a deep venous thrombosis.
Regarding the abdominal abscess, the surgeon would be the primary physician taking care of this. Surgical therapy is the mainstay for abdominal abscesses. Antibiotics are normally used as secondary role. Unfortunately, you are doing all you can with the abscess by keeping in close contact with the surgeon. Repeated CT scans are used to track the progression of the abscess.
For the deep venous thrombosis, anticoagulation (blood thinning) should be done if there are no other complications contraindicating this (i.e. if the patient is prone to a GI bleed, then anticoagulants would not be suggested - an IVC filter could be placed instead). The reason for this is to prevent a blood clot from travelling into the lungs. A general practictioner or internal medicine physician should be able to manage this, in conjuction with the surgeon. Typically anticoagulation for the first episode of deep venous thrombosis is for 3-6 months.
Regarding the diarrhea, there are many causes for this. I assume that your husband has been on antibiotics for his multiple surgeries. A test for Clostridium Difficile (a bacteria causing diarrhea) should definitely be performed. This can be done with a stool sample. If positive, then appropriate antibiotics should be prescribed. Regular stool tests for culture and ova/parasites should also be performed.
An internal medicine physician should be able to take care of all the medical issues except for the surgical issues (i.e. the abscess). If you are not obtaining satisfactory answers from your physician, I would recommend finding another opinion.
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.
You are describing an abdominal abscess, multiple surgeries for colon cancer and subsequent complications (adhesions), diarrhea, and a deep venous thrombosis.
Regarding the abdominal abscess, the surgeon would be the primary physician taking care of this. Surgical therapy is the mainstay for abdominal abscesses. Antibiotics are normally used as secondary role. Unfortunately, you are doing all you can with the abscess by keeping in close contact with the surgeon. Repeated CT scans are used to track the progression of the abscess.
For the deep venous thrombosis, anticoagulation (blood thinning) should be done if there are no other complications contraindicating this (i.e. if the patient is prone to a GI bleed, then anticoagulants would not be suggested - an IVC filter could be placed instead). The reason for this is to prevent a blood clot from travelling into the lungs. A general practictioner or internal medicine physician should be able to manage this, in conjuction with the surgeon. Typically anticoagulation for the first episode of deep venous thrombosis is for 3-6 months.
Regarding the diarrhea, there are many causes for this. I assume that your husband has been on antibiotics for his multiple surgeries. A test for Clostridium Difficile (a bacteria causing diarrhea) should definitely be performed. This can be done with a stool sample. If positive, then appropriate antibiotics should be prescribed. Regular stool tests for culture and ova/parasites should also be performed.
An internal medicine physician should be able to take care of all the medical issues except for the surgical issues (i.e. the abscess). If you are not obtaining satisfactory answers from your physician, I would recommend finding another opinion.
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.
Member Comments (1)
by surgeon, Apr 10, 2003 12:00AM
If he still has drainage that is coming from an area of the intestine, it may be that he'd be better off in the hospital getting hi-dose intravenous feedings, and putting the bowel at complete rest. Antibiotics probably won't do much, and could lead to overgrowth of bugs not sensitive to it: unless there's a known specific infection requiring it. These are very difficult situations, and take a long time to resolve. If you are not comfortable with the care he's receiving, probably an evaluation at the nearest university medical center would be a place to get another opinion.
