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Colectomy Complications

  My mother was diagnosed with Ulcerative Colitis in Feb '96.
  She had a total colectomy in Nov.'96,and currently has an ileostomy.
  Surgery was to be in 3 segments:
  1-Removal of Colon
  2-Creation of Pouch
  Her Colon was removed and the pouch was created.
  She now lives with a drainable pouch, awaiting the third surgery.
  The problem is, she suffers from hypermotility  (every piece of
  food runs through her system so quickly and empties into the pouch
  in a matter of minutes) and malabsorbtion (nutrients, vitamins,etc.
  are unable to absorb into her body).  Because of this, she has
  been hospitalized 6 times for dehydration, which really does a
  number on her kidneys.
  The 3rd surgery will never take place until food begins absorbing.  
  Not a single doctor in the past year has been able to figure
  this one out. Why is nothing absorbing?? Should she be on
  a particular diet?? What if reconnection took place now??
  She has been prescribed  Opium, Sandistatin (sp). Questran,
  among others to try to solidify things, but NOTHING has
  worked. She must empty the pouch 11-16 times a day, which makes
  it rather difficult to do much. She has accepted the fact that
  she may have to live with a pouch the rest of her life, but
  she cannot continue with the malabsorbtion and hypermotility.
  If anyone has any medical advice, or experienced
  anything similiar, please let us know.
Dear AB,
High out put ileostomy states are not the same as malabsorption.  In high output states, there is usally a problem at the ileostomy, inflammation, foreign body, Ctohn's Disease etc.  The high output staes leads to large volumes of water and electrolytes being lost.  Dehydration can result but there is usually no malabsorption of vitamins or nutrients.
Small intestinal diseases or pancreatic diseases causing malabsorption can also cause large volume ileostomy outputs but in this case the problem is not in the ileostomy  but elsewhere in the GI tract.  Conditions such as celiac disease, infectious small intestine disease can cause high volume ileostomy output and malabsorption of nutrients.
In this case, it is necessary to have an understanding of the cause of the high output state.  Your mother needs an endoscopic ileostomy examination as well as an upper endoscopy with small intestine biopsy as the initial workup.  Therapy is directed to treatment of the underlying problem.  Sometimes, the diarrhea does resolve when bowel continuity is reestablished.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the necessary investigations after we have had the chance to meet you and to review your history in greater detail. Depending on our assessment of your problem, we would then refer you to the appropriate surgeon.  You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of intestinal disorders by calling the Henry Ford Physician Referral Line at (800)653-6568.

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