Ruptured Colon

[leslie7691]

My sister recently went in for yearly checkup and had a colonoscopy done on Aug. 9th.  She was told that she has colon cancer and was scheduled for surgery to remove part of her colon, on Monday, Aug. 16th.  During her recovery at the hospital, she experienced extreme nausea and a continuous fever. She began throwing up black nasty liquid on Wednesday, Aug. 18th and again green nasty liquid on Thursday, Aug. 19th.  Her stomach was so large it looked like she was nine months pregnant.  Her doctor started giving her nausea medicine, and although she was still running a fever of 99 and stomach still swollen, but not as large, he released her to go home on Sunday, Aug. 21st.  She only drank some water and ate small bites of bread for the next few days because she was still experiencing the nausea.  She had used the bathroom only twice in those few days, which were liquid with small particles.  On Wednesday, Aug. 25th, she returned to her doctors office for a follow-up and was told there was good news and bad news.  Good news was all the cancer had been removed; bad news was she would have to have surgery again because the doctor believed her colon was twisted, which was the cause of the nausea and remaining fever for the past few days.  She went in for surgery again on Thursday, Aug. 26th to straighten out the colon.  Doctor explained that her was not twisted, but that it actually had a huge hole where the perforation was done on the first surgery.  He explained that she would have to wear a bag and that he could not repair the colon right now and will have to wait until it heals.  Currently she in the hospital, just a regular room, and has had numerous visitors.  After do some reading online about a ruptured colon, shouldn't she be in some kind of isolation and away from people who could inadvertently spread an infection around her?  What steps, as a family, can we take to insure proper care is given to her for such a life threatening situation?  What kinds of questions do we need to be asking her doctor and/or the nurses?

[HarringtonE]

It is very strange for me to listen that her doctors allowed her to go home. They should asked her to take rest because may be her colon has not got properly removed. i think it is the total negligence of doctor.

[joanty]

I was reading your post and was wondering if maybe you can help me.  My friend went in for bypass surgery she had blockage in one leg and some where down past her heart.  After surgery is became very sick throwing up green she cannot hold any food down .  The doctor after 3 weeks in the hospital told her she had a obstruction in the bowls and they had to go back in and they said something flipped and they had to fix it.  now 2 weeks later they sent her home from the hospital and she is still throwing up green and she is still sick to her stomach.  I don't no what to do with her anymore she called 911 and was taken back to the hospital they took more tests and the doctor said to give her some nausea medicine and send her back home.  now she is home sick to her stomach and cannot eat I think they put a hole in her colon and no one is finding it what should I do with her help pls

[mammo]

This woman was sent home too soon, that's quite obvious.  You admit that the surgeon may have perforated the bowel.  I have way too much experience with doctors and their egos and how they cover for one another!  Just the fact that you even suggest a second opinion tells me you're suspicious as well.  It really doesn't matter how badly a doctor feels, his life goes on uninterrupted, while the patient pays the price.  I worked for 2 Gastroenterologists for many years and I could write a book on the unethical behavior I've seen.  I know there are good ones and bad ones, as you do.  Some board certified, some not.  I also know I lost a son to negligence, and this is why I tell people to question everything they are being told, and NOT told.

[kocherize]

Hi Leslie...I hope things are going better for you and your sister.  I saw mammo's last post and just had to respond.  I am a colorectal surgeon.  I obviously don't know the details of your sister's care, and by what you're describing, it may have been the case that she was sent home too soon.  In any case, as I stated before, I believe what you're describing is an anastomotic leak, or a breakdown in the connection between the two ends of the colon where a portion was removed.  It doesn't sound like the surgeon actually "perforated" the bowel, but it's possible.  I would ask the surgeon directly to clarify what happened.  With any colon surgery where a portion is removed and reconnected, there is always a risk that the connection can leak.  The further downstream you go, the higher that risk.  So for right-sided colon surgery the leak rate is about 2-5%; however, for rectal surgery (lowest end), leak rates can be as high as 10%.  If she did have a leak, it's advisable most of the time to disconnect the bowels, create a colostomy and wait a minimum of 6 weeks before trying to reconnect things.  Trying to reconnect right away is usually not a good idea, because there's a high risk of that new connection breaking down.  As for reconnecting her in the future, the timing depends on several things.  First, does she need chemotherapy and for how long?  If she needs chemo, most of the time we allow the patient to complete the chemotherapy and then have the surgery to reconnect things.  The reason we wait is that if she needs chemo for, say, 4-6 months, you don't want to interrupt the chemo in the middle.  Remember that her surgery to reconnect is a major one and she will need several weeks to recover, during which time she may not be strong enough to get additional chemo.  I obviously don't know anything about your surgeon...ask him questions.  I'm sure he feels very badly about this complication...we've all had leaks and we hate them.  If you're not happy with your surgeon, if you wish I may be able to refer to a reputable one in your area if you wish.  Again, best to you both.

[mammo]

They throw in that 10% to cover their a...s!   It is caused by the surgeon during the surgery, and if they were being careful they would have re-checked before ending her surgery.  They can perforate the colon at any point.  Chemo involves the injection of a chemical into the bloodstream, I assume they don't want her vomiting or feeling any worse than she already does.  I'm assuming the perforation is below the stoma so that nothing is passing by it?  I would ask "why" they have to wait, and how will waiting affect her.  But then again this doctor may just tell you what he wants you to hear.  I'm sorry if I sound so skeptical of this doctor, I lost my son to doctors just like this one and it should never have happened.  By the time we got him to a fourth GI they were able to give us 2 more years with him.  His body was so ravaged from a botched surgery and them withholding information that we lost him.  So, I am a very big advocate of second, third, and fourth opinions.  The medical student that graduates at the bottom of his class is still called doctor!  Good luck to you both and take care...

[leslie7691]

You say that there is a 10% chance this could occur from surgery.  I am curious if you are referring to this happening during surgery or this could happen days after the surgery?

My sister mentioned several times during the evening of Aug 19th, 3 days after surgery, that she was dying, that they are trying to kill her.  I now believe, without a shadow of doubt, that she knew more about what her body was going through than the surgeon or the hospital staff.  She knew herself something was not right and not one medical staff questioned why she would think that way, they just gave her more pain medicine and nausea medicine.  How it takes her surgeon a week (7 days) to (only think) something is wrong (twisted colon), just amazes me.  

Her white blood count is down to 12,000, which I'm assuming is still a little high.  We're being told 10,000 is normal.  She will still be in the hospital for several more days.  The doctor says he can repair the colon again in 6-8 weeks.  Does that sound correct?  Also, what risk are involved with taking chemo right now?  Should she wait till colon is repaired?  Only suppose to be a light form of chemo, she will not loose her hair, but are there any risk to taking chemo while still having a ostomy bag attached?  Which portion of the colon has the 10% risk of perforation from surgery?

[kocherize]

Leslie, it sounds like your sister has had an unfortunate but sometimes unavoidable complication from colon surgery.  I believe you are describing an "anastomotic leak," or a leak at the connection of the colon where a portion was removed for her cancer.  This complication can occur in up to 10% of patients depending on which portion of the colon was removed.  Unless she has an unusual infection, receiving visitors should be ok, but make sure she is getting her rest.  She will likely be in the hospital another week after her 2nd surgery, but it could be longer.  She should be prepared to have the bag (also called stoma or ostomy) for at least a couple months.  Best wishes to you and your family.

[mammo]

For starters, that doctor was negligent in perforating her colon.  Second she should NEVER have been sent home in her condition.  Having the bag does not subject her to any harm from bacteria.  My son had his colon removed at 12 and had the bag for three months while things healed.  He played in the creek, went to school and did everything (but swim) that a normal 12 year old would do.  I'm confused as to how they CANNOT close the hole now, because this is allowing intestinal fluids and food to enter into her abdominal cavity which is very serious.  I think I would seek a second opinion from another Gastroenterologist regarding this.  Does she have a drain that is allowing what has already leaked into her abdominal cavity to drain?  A perforated colon is very serious and is normally corrected immediately.  Maybe I'm missing something here, but I too, would be very concerned, and I don't think I'd want that doctor anywhere close to her!  Your poor sister, she should never have been in this condition, and is paying the price for the doctor's negligence.  I do wish you both all the best and take care.