Anyone have a rectal stump blowout?

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draegs
Regular Member


Date Joined Jun 2008
Total Posts : 31
   Posted 10/20/2008 7:13 PM (GMT -6)   
This is a question for those of you who had a total colectomy to rid yourself of Ulcerative Colitis:

Did any of you experience a "blow out" of your rectal stump after the surgery? I went through one myself, but I haven't run into any stories of anyone else experiencing this complication. My surgeon told me that it is rare, but possible with any patient suffering from UC. He went so far as to say he expected it to happen at some point between my first and second surgeries. I just wish he had warned me about it ahead of time! Although, I do understand his reasoning that he doesn't like to scare his patients by going into detail about all the many possible, rare complications that can come up.


For those interested, this is my story as posted to my blog:

"Friday morning [10 days post-surgery] I woke up to a new pain at the bottom of my incision. Upon closer inspection, I found that a hole the size of a pencil eraser had opened up. Even better was the fact that it was leaking a good deal of this mucous-like fluid. At times it was even coming out in a steady stream. I didn't worry too much about it, though, as the wound care nurse was coming that morning to check me out and give me another lesson on changing my ileostomy bag.

Jennifer came and did check it over and said it looked okay to her. I didn't exhibit any of the physical symptoms of infection (fever, chills, vomiting, etc.) and the fluid coming out wasn't of an unhealthy color or odor. Apparently she felt it was worth informing my surgeon of, however, as I later received a call from his assistant. She explained that this was common in some patients following surgery and that I should simply keep an eye on it over the weekend. If things worsened, they could squeeze me in today and take a look at it.

Saturday saw a slight increase in the size of the opening and moderate increase in pain. It was the change on Sunday that had me concerned. I woke up to some serious pain and looked to see that the opening had swelled to nearly the size of a grape. It looked as though it was working its way north, busting stitches open along the way. I called the emergency contact number and talked with the colorectal surgeon on duty. His advice was to wait it out until today if possible. He felt I wasn't in any immediate medical danger and that it wasn't worth my time to drive over and wait it out for a couple hours at the ER to see someone. I thought this made sense as it should be the guy who did the original work who looked it over if possible. So I left Vicki a message explaining what had happened and told her that I had to get in one way or another.

I ended up with a 2:30pm appointment this afternoon. After getting back to the exam room I was eventually greeted by my surgeon, his assistant, and a stoma specialist nurse. They stripped me of my bag and dug into examining my new opening. Although he was surprised at how tender the area was, the doc insisted that there was nothing unusual about its size or the fluid inside. He went on to explain that all of this actually happened for a good reason! Had this not been the case, I would have been extremely ill with an internal infection and probably checked into the ER by this time. Let me explain...

When the first stage of surgery is performed, the rectum is left behind as a holder for the sphincter. While the sphincter is a necessary part of the final product, the rectum is removed in the second stage when the j-pouch is created. Because the symptoms of Ulcerative Colitis are created by an overactive immune system, this organ can still be affected even without any food waste passing through it. Most people experience some level of inflammation as a result and, in some cases, this causes the rectum to "blow out" at some point. The surgeons plan for this possibility by grafting the top of the stump to the abdomen, at the bottom of their incision. That way if the rectum does fail, it weeps to an external drain and not into the internal cavity.

My surgeon said he was pretty certain this was going to happen to me based on how far gone my colon and rectum were at the time of the surgery. He also said he did not go into details of this possibility with his patients ahead of time because of the odds favoring they may never experience it. I understand where he is coming from with that approach, but it still would have been nice to know ahead of time. Then again, there's probably a bunch of other possible complications that I am better off not knowing about because they will never affect me.

They flushed me out and packed the opening with gauze. I was instructed on how to perform the packing so I can repeat the process twice a day for the next few weeks. He tells me that within 4-6 weeks it will almost completely heal from the inside out. The opening itself will never close completely, however, and some small amount of fluid will always drain until the next surgery. Yes that sucks, but it's a healthy process and there's much worse I could be having to deal with. It's nothing that can't be handled by simply coving it with a bandage and some gauze.

In the end, it does suck to still be in pain and to have this wound to take care of. The thing is, I really don't care a whole lot because the ileostomy is working so well. I'm hungry all the time now and love being able to pick and choose whatever I want to eat (with a few minor exceptions). Such a huge psychological boost, this alone has really made me feel like I have my life back. I went into this whole process to gain that freedom back and so this other issue is only a temporary inconvenience.

I'd take the lifestyle I have even now over where I was at two weeks ago (pre-surgery) in a heartbeat!"
James
26-year-old diagnosed with UC in 2004
Underwent stage one of J-Pouch surgery on September 16, 2008
Now living symptom-free


flchurchlady
Veteran Member


Date Joined Jul 2007
Total Posts : 2764
   Posted 10/20/2008 9:22 PM (GMT -6)   
That didn't happen to me, but it sounds like you've handled it really well and have a positive attitude about it. Isn't it great to be disease-free? :-)
Dx'd Crohn's in '99 at 28. Proctocolectomy and ileostomy in '06.
Disease-free, medicine-free, and very thankful to be healthy again :)


GISGuy31
Regular Member


Date Joined Feb 2008
Total Posts : 79
   Posted 10/30/2008 8:02 PM (GMT -6)   
Your having a rare complication happens to 15% of the patients that have just the colon removed during the first stage of a 3 stage j-pouch surgery and the remaining stump has formed a fistula (or duct) to your incision or other part of your body. I'm someone who is also lucky enough to have the same complication.

However, mine came after being operated on again after an unexpected blockage from scar tissue that choked off my small intestine, while I was still waiting to have my second actual j-pouch surgery. They went through the same 10" incision (I had an open colectomy) and removed the scar tissue and stapled my belly back up. Then, I barely remember because I was on so much morphine, about 2 days after the surgery, a nurse stopped by and said "I need to take a few staples out". I remember them saying something about having a lot of pressure in my abdomen and being distended. I was so doped up, I don't actually remember her doing it. Then, they kept packing the wound like 3 times a day with 1/2" wide strip of gauze about 3' long (and it gradually got shorter and shorter as the days/weeks went on). It has since closed up to the size of a dime (took about 6 weeks), I call it my second belly button. I now have a crater below my belly button that oozes mucus throughout the day...I would say about 2 to 3 tablespoons worth a day. I was supposed to have my second surgery on Sept 25, but now it has been pushed back to Nov. 20th. Yeah, I didn't like the idea of having a gaping wound oozing mucus for that long (it will not close until the rectal stump is removed), so I scheduled the next surgery as soon as possible. They will not operate through the same incision, unless you let 3 months pass, otherwise the incision can burst open.

Anyway, the visiting nurse told me something funny. After the hole closes up as much as it will (when you can stop packing it), instead of using those expensive gauze pads, she said take a maxi pad, the "light days" cut them in half, and then just use surgical tape and tape it so it covers the hole. I've been to work for the past 1.5 months with half a maxi pad taped on my belly!!! Pretty funny and nobody knows. I also got my doctor to write a note to allow me to wear sweat pants until the next surgery because this wound is right on my waist line. So I go around in my office with sweatpants on and a tee-shirt for a total of 2 months - it's like being constantly dressed down...I love it. All they know is that I have an open wound on my waistline and that won't heal until my next surgery. I wore a suit and dress pants with belt during the last two days to a conference and it irritated the heck out of it, and it even bled a little bit with the mucus. So now I'm back in sweat pants again until the next surgery. I change the pad about 2 to 3 times a day (first thing in the morning, then maybe after work, and before I go to bed. A clear "outtie" belly button has now formed in the center of the crater from which the mucus oozes out, so I guess I truly do have two belly buttons now. There isn't a hole to pack after about 6 weeks...and I could have easily fit a half a roll of quarters in that hole when they opened it up.

I guess it is just something I'll have to enjoy until my next surgery, where they will form the j-pouch and remove the rectal stump. I'm even considering having my real belly button removed as well since it's all deformed now (it's funny how they tried to cut around it). It should be interesting to see what happens.

Good luck, and your not the only one who has gone through this!!!
Age 0 to 30 - 100% healthy, no meds, no doctor visits, no hospital stays
Oct. 2006 - Symptoms of UC began
3/5/2007 - Diagnosed with UC - Pancolitis (entire colon involved)
20mg-40mg/day Prednisone, 4.8 g/day Asacol - didn't work at all
10/12/2007 - Steroid Induced Osteoporosis from Prednisone and Anemic
add Actonel (75mgx2 pills/month) and daily iron pills
2/12/2008 - open Subtotal Colectomy with Temporary Ileostomy Surgery
8/05/2008 - Unexpected surgery to remove blockage caused by scar tissue
11/20/2008 - J-Pouch Surgery and possible Ileo Reversal Surgery Scheduled
"When life gives you lemons...make lemonade"


GISGuy31
Regular Member


Date Joined Feb 2008
Total Posts : 79
   Posted 10/30/2008 8:10 PM (GMT -6)   
I checked some of your earlier posts...Dr. Remzi is my surgeon also, but he was on vacation when I had the scar removal surgery, someone else did that one. Dr. Shen is my GI doctor. I live near the Akron/Canton airport. What a small world. Good luck.
Age 0 to 30 - 100% healthy, no meds, no doctor visits, no hospital stays
Oct. 2006 - Symptoms of UC began
3/5/2007 - Diagnosed with UC - Pancolitis (entire colon involved)
20mg-40mg/day Prednisone, 4.8 g/day Asacol - didn't work at all
10/12/2007 - Steroid Induced Osteoporosis from Prednisone and Anemic
add Actonel (75mgx2 pills/month) and daily iron pills
2/12/2008 - open Subtotal Colectomy with Temporary Ileostomy Surgery
8/05/2008 - Unexpected surgery to remove blockage caused by scar tissue
11/20/2008 - J-Pouch Surgery and possible Ileo Reversal Surgery Scheduled
"When life gives you lemons...make lemonade"


Crohned
Regular Member


Date Joined Jan 2007
Total Posts : 86
   Posted 10/31/2008 6:40 AM (GMT -6)   
My rectal stump also blew. What a weird thing to type. What an even weirder thing to experience. I knew something was wrong right after surgery when the lower incisional pain was so severe that I wasn't able to ambulate the hallways as instructed. My surgeon and his minions were never concerned with this until I presented with a septic decline on post-op day #3 while still in the hospital. They opened my incision back up at the bedside. It was definitely infected. The docs explained that this stump blowing is a risk/complication of surgery but that the enormous hole now in my lower abdomen would eventually close off over time. Super. The nurse fitted me with an additional ostomy bag to catch all the drainage. I flew home emergently (the surgery was at the Cleveland Clinic) in order for my gastro doc to manage my care. We opted to place a wound vac in the hole which I wore for about three weeks.
Diagnosed Crohn's/Colitis 2003.  
Subtotal Colectomy w/ Ileostomy May 16, 2007.
I'm off the meds!!  
 


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3071
   Posted 10/31/2008 8:01 AM (GMT -6)   

Wow...you guys have been through A LOT!!  That didn't happen to me, but I am glad to see that you are handling it so positively.  Knowing that packing is "temporary", so to speak, can make having to do it easier!!  I freaked out with the first packing I did, but after that it seemed to get easier for me:(

GISGuy31--it really is a SMALL world...we were in the CC, for our surgeries, at the same time AND we are neighbors!!  Infact, the 5:50AM flight from Akron/Canton wakes me up every day!!

Here's a question: does that happen more in males?

draegs
Regular Member


Date Joined Jun 2008
Total Posts : 31
   Posted 10/31/2008 4:39 PM (GMT -6)   
I hope you were as happy with the work Dr. Remzi did for you as I am with mine, GISGuy. I was lucky enough to get away with only a 5-inch incision, however I also have a mutilated bellybutton (the incision goes right through it).

It's been about 6 weeks now and my hole is smaller than a dime. It still oozes a small amount of mucous, but changing the bandage at night and applying a new one after my shower in the morning is all I need to do. I was even able to stop packing it a week ago.

I'm not excited about it being around until March (six months between surgeries for me), but only because mine is also right on my waistline. I can relate about the irritation that "normal" pants and a belt bring about. Thank god someone invented sweatpants and track pants.

Reading your signature, it looks like he has mentioned possibly doing stages 2 and 3 at the same time. He mentioned the same possibility to me during my check-up last week. I'm not sure how I feel about that yet.
James
26-year-old diagnosed with UC in 2004
Underwent stage one of J-Pouch surgery on September 16, 2008
Now living symptom-free


GISGuy31
Regular Member


Date Joined Feb 2008
Total Posts : 79
   Posted 10/31/2008 5:18 PM (GMT -6)   
Yeah, I think he likes to tell you what you want to hear, then you wake up with a conservative approach that he probably always had in mind. I'll let you know if he combines them for me, which would be great, but I'm counting on the two surgeries anyway. He also said I had a 95% chance of having everything done laproscopically before the first surgery, but I woke up with the 10" incision instead. I was in really bad shape going into the first surgery anyway, but I feel normal and I'm medicine free, so just the first surgery was worth it for me. Now I'll be glad to leave the bag and try the j-pouch thing, but I know this would be the "worst case scenario" if the pouch ever failed. At least now I have a life again and things can only get better.
Age 0 to 30 - 100% healthy, no meds, no doctor visits, no hospital stays
Oct. 2006 - Symptoms of UC began
3/5/2007 - Diagnosed with UC - Pancolitis (entire colon involved)
20mg-40mg/day Prednisone, 4.8 g/day Asacol - didn't work at all
10/12/2007 - Steroid Induced Osteoporosis from Prednisone and Anemic
add Actonel (75mgx2 pills/month) and daily iron pills
2/12/2008 - open Subtotal Colectomy with Temporary Ileostomy Surgery
8/05/2008 - Unexpected surgery to remove blockage caused by scar tissue
11/20/2008 - J-Pouch Surgery and possible Ileo Reversal Surgery Scheduled
"When life gives you lemons...make lemonade"


GISGuy31
Regular Member


Date Joined Feb 2008
Total Posts : 79
   Posted 10/31/2008 5:27 PM (GMT -6)   
Wow OHIO76, that is really close we are probably neighbors. I'll just say I live on the busy road between a post office and the Raintree Country Club. That's pretty wild.
Age 0 to 30 - 100% healthy, no meds, no doctor visits, no hospital stays
Oct. 2006 - Symptoms of UC began
3/5/2007 - Diagnosed with UC - Pancolitis (entire colon involved)
20mg-40mg/day Prednisone, 4.8 g/day Asacol - didn't work at all
10/12/2007 - Steroid Induced Osteoporosis from Prednisone and Anemic
add Actonel (75mgx2 pills/month) and daily iron pills
2/12/2008 - open Subtotal Colectomy with Temporary Ileostomy Surgery
8/05/2008 - Unexpected surgery to remove blockage caused by scar tissue
11/20/2008 - J-Pouch Surgery and possible Ileo Reversal Surgery Scheduled
"When life gives you lemons...make lemonade"


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3071
   Posted 10/31/2008 8:25 PM (GMT -6)   
Im the other side of the airport!

Colonless girl
New Member


Date Joined Mar 2013
Total Posts : 1
   Posted 3/28/2013 5:37 PM (GMT -6)   
Hi all

I'm new to this whole thing after only having surgery 7 weeks ago but I was so pleased to read this thread after hearing about the dreaded rectal blowout and worrying I was going to have it! After reading about everything you have been through I now at least understand what I haven't got!!!

I've had a total colectomy for UC and am still getting pain, but it seems to move about all over the place. It's a genuine surprise every day and a lucky dip with what's gonna hurt next. The more it moves about, the more I worry but maybe you can provide me with some reassurance if you can. I had the original surgery via keyhole but then had another surgery to drain fluid. At the moment I have pain around the incision and I can feel the rectal stump if I touch my lower abdomen. I don't remember this before and I'm terrified that there's a problem.... After spending 9 weeks in hospital I don't want to go back. I hope you have some advice for me, I'd really appreciate it I'm so new to this that I'm grateful for anything you can suggest... Even if it is " stop being paranoid and get on with it!!! turn

ActiveUCer
Veteran Member


Date Joined Jul 2012
Total Posts : 1685
   Posted 3/28/2013 6:05 PM (GMT -6)   
I didn't have a top blow-out, but I had the same "tack the remaining rectum to just below the skin" thing. I did know beforehand why that happens. I'm a "why" person. "Why are you doing this? why are you doing that?" Poor doctors.

Sorry you had the trouble, but then again I'm glad that the tacking worked as expected!
http://activeguts.wordpress.com/

Drug refractory UC
Colectomy with end ileostomy August 30th, 2012 - jpouch sometime
IBD related arthritis and peristomal pyoderm gangrenosome

Humira, finally off of steroids! Aiming to have Step 2 in August 2013.

Tried lots of drugs and diet, didn't work for me.

Annettemarie
New Member


Date Joined Aug 2013
Total Posts : 1
   Posted 8/17/2013 6:14 AM (GMT -6)   
I am so grateful to have found this thread as I am 16 days post ileostomy and my rectal stump is still intact. My surgeon mentioned rectal stump blowout and its given me nightmares ever since. My stump is passing blood and mucus and I have strange pains and its worrying me. My open surgery scar is OK and there are no openings or anything but I am constantly worried about the stump.
Has anyone had any internal problems with the blowout, such as it not leaking out your scar? How long is the risk of blow out present, is it until the stump comes out...I don't think I can wait a year with it constantly playing on my mind.

Sorry feeling wimpy today.

Peace&Harmony
Veteran Member


Date Joined Jul 2010
Total Posts : 1121
   Posted 8/17/2013 10:08 AM (GMT -6)   
Ok I'm a bit confused. What exactly is a rectal stump blow out?

I never planned on the j-pouch but my surgeon let me keep my anus as he claims there are more complications with removing it. I had 2 abscesses and now a fistula draining out seepage through my anus. I have a surgery consultation and it seems they will be removing the stump.

Is this the same thing?
Diagnosed with UC, July 2010
proctocolectomy with end ileostomy, Sept 2012
Bye Bye UC!
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