colonectomy complications

[Rick 01]

My mother has been hospitalized twice in the past 4 weeks from complications arising from her chemotherapy regimen, she recently suffered severe neutropenia and almost died from severe infection. She eventually recovered after 2 weeks of intensive treatment with antibiotics and was sent home. About on week ago she started suffering from nausea and diahrea, she was admitted to the hospital and was told she had colonitis (colitis) ( megacolon). later that night she crashed and had to be incubated, the doctors told us the infection in her colon was releasing deadly toxins into her bloodstream and that surgery was the only option.
Her colon was removed on wed (3/10/04. Improvement was noted the first 48 hours but then her platlet counts started to drop ( currently at 14) she has been recieving platlet infusions, but they continue to fluctuate between 14 and 26. Today (3/15) we were informed that her biliruben was 8 and her liver was enlarged. the hematologist has not told us how they plan on treating her and we are desperate for some answers.

PLEASE HELP.

[Kevin Pho, MD]

Certainly after chemotherapy, this suppresses the immune system and predisposes one to infection.  The fact that emergency surgery was necessary markedly worsens the prognosis.  

With the bilirubin at 8, it suggests that there is some sort of liver pathology going on.  Various basic tests should be considered, including ultrasound or CT scan.  If there is evidence of any type of acute cholagitis, this requires aggressive antibiotic therapy.  

Again, without more information, there are many reasons why this can happen.  However, you are entitled to answers and an explanation and may want to consider another opinion if you are not able to obtain answers from the current team.  

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]

These situations are very difficult when all the information is available; from afar, without knowing all the details, including why she's had chemo, various other findings, it's nearly impossible to give much information. It's natural to seek answers from all available resources, but the best info can only come from her doctors in such a situation. Having performed emergency colon resections in similar circumstances, I can tell you, as you must already know, that the situation sounds very grave. The combination  of weakened bone marrow from chemo, and the suppression that's added to it from the infection means her ability to fight infection is very compromised. Even without chemo, when there's severe infection like hers, other organs are highly stressed as well; the elevated bilirubin is most likely from that sort of stress on the liver, and the only things that can be done about it is to support her with ventillation, fluids, antibiotics, heart and blood pressure drugs as needed -- and to rule out other causes that could require other treatment, such as gallbladder infection, abscess, etc. The doctors and nurses taking care of her are much more able to supply details, prognosis, and plans.