Rectal catheter the norm following surgery?

As far as you know, is a rectal catheter the norm after Colectomy with Ileorectostomy?
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0
No - 0.0%
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I don't know - 100.0%

 
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Aiming for Serenity
Regular Member


Date Joined Feb 2009
Total Posts : 32
   Posted 2/12/2009 3:38 PM (GMT -6)   
A close friend recently underwent a full colectomy and ileorectostomy (he had his colon removed and his small intestine reconnected to his rectum). He had some major problems following the procedure, but thankfully he survived. It's my understanding that the problems he had were very unusual and occur infrequently.
 
I'm trying to piece together some information about what might have led to his post-surgical problems. I'm wondering whether it's the norm to have a rectal catheter in place for a few days following a colectomy with ileorectostomy? Thanks in advance for any experience you can share.

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5690
   Posted 2/12/2009 4:02 PM (GMT -6)   
Is this surgery the same as an ileorectal anastamosis? I do believe catheters are infrequent. But all of the colorectal surgeries come with possible complicatons; there's a host of them. Most people get beyond the initial complications and are fine.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Aiming for Serenity
Regular Member


Date Joined Feb 2009
Total Posts : 32
   Posted 2/12/2009 4:20 PM (GMT -6)   
Yes, I believe Ileorectal anastomosis is the same as colectomy + ileorectostomy.

I beleive my friend will fully recover, but we're trying to understand what happened (which I haven't described purposefully as I don't want to influence responses).

Thanks!

Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 2/12/2009 4:50 PM (GMT -6)   
I had a total colectomy with temporary ileostomy, and I had a rectal drain in for the full 5 days of my hospitalization. It didn't bother me at all for the first few days, but the last 24 hours it hurt like heck, I think it may have gotten jostled. There was only a tiny bit of drainage the whole time, most of it occurred the first day after surgery. I was told by both the surgeon and the nurses that it was not optional, and I will be having it also after surgery #2 when the j-pouch is formed, but not after surgery #3 when things are reconnected.
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for '09 to form j-pouch


Aiming for Serenity
Regular Member


Date Joined Feb 2009
Total Posts : 32
   Posted 2/12/2009 6:51 PM (GMT -6)   
Thanks, Pibbin, for sharing your experience and expections for your upcoming surgeries.

Did they give you any information that you could pass onto me that would help me understand why it wouldn't be necessary after reconnection (your third surgery)?

tbraz
Regular Member


Date Joined Jul 2007
Total Posts : 280
   Posted 2/12/2009 7:40 PM (GMT -6)   
I only had the rectal catheter after my colon was removed. When I had the second surgery of them forming the pouch I didn't have one, nor did I when I had the takedown.

I can only assume that because I had so much rectal inflammation with the UC, they used the catheter to let it continue to drain. I think that I only had it 3-4 days after the surgery and couldn't wait to get it out. It's normal to continue to have a bloody/mucous discharge until the takedown.

It sounds like your friend had it all done in one step? Or does he have a temporary ileostomy?
Theresa

Originally diagnosed with CD in 1991
Now saying "Undetermined Colitis"
3 step Jpoucher as of 4-15-08


Aiming for Serenity
Regular Member


Date Joined Feb 2009
Total Posts : 32
   Posted 2/12/2009 8:12 PM (GMT -6)   
Yes my friend had it all done in one step. He doesn't have a J-pouch or anything... his colon was removed and his ileum was reconnected to his rectum. Therefore I believe his post-surgical experience would differ greatly from Pibbin and tbraz. You both had rectal drains but would have had non-fecal discharge whereas my friend had fecal discharge immediately following his surgery. (Thank you both so much for sharing your experiences with me. I hope you are well and future procedures go well.)

I'm looking for information regarding whether a rectal catheter is recommended for fecal discharge immediately following ileorectal anastamosis.

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 2/12/2009 9:29 PM (GMT -6)   
I think Schrek-Chewbacca Hunk mentioned a rectal catheter in one of his posts...I am not sure of his circumstances. Hopefully he'll be along to post.

I hope your friend is feeling better with every day...

Chasblah
Veteran Member


Date Joined Feb 2007
Total Posts : 788
   Posted 2/12/2009 9:55 PM (GMT -6)   
I had one too.
They kept it in the whole time I was in the hospital and removed it the day I was released.
Didn't bother me at all.

I had a different surgery than your friend sorry.
Chassity
28 yrs. old. married with one beautiful daughter (born 11/20/07)
-diagnosed with severe pancolitis u/c 2002 had total colectomy 12/19/08; emergency surgery due to abscess-had to redo ileostomy and switch to left side 12/25/08; 1/29/09 found blood clot in superior mesenteric vein (prob. from inf. and surgery inflammation)
pred. taper, coumadin, carafate, prenatal vit., and pain meds
(ileostomy temporary....not so sure?)

"Things turn out the best for those who make the best of the way things turn out."


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 2/14/2009 1:29 PM (GMT -6)   
I'm not sure if I'm remember clearly (lots of morphine, LOL), but I thought they told me that in addition to drainage, it was to keep the rectum from collapsing/hold it's shape. ??

The drainage was not fecal in matter, but appeared to be old blood/mucus.
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for '09 to form j-pouch


Aiming for Serenity
Regular Member


Date Joined Feb 2009
Total Posts : 32
   Posted 2/17/2009 4:43 PM (GMT -6)   
Thanks much to all who replied. The doctors aren't being straight with my friend, but we (his family and friends) have pieced together some things based on doctor statements and their reactions to each other. We believe my friend was supposed to have had a rectal catheter in place for several days following the sugery, but did not. It hadn't been discussed with him at his pre-op meeting so he didn't expect or miss it. When the medical team came to take it out they found he didn't have one. (He had to tell them three times he didn't have one before they believed he really didn't.) We all recognized that, uh, yeah, that would have been a good thing to have had in place. Instead, he had constant watery-diareah-like movements and was trying to make it to the bathroom from within hours after surgery. He often didn't make it, but he tried. (And none of the medical team acted like this was out of the ordinary, so we all accepted it as the norm.)
 
He ended up with a "leak" at the site where his ileum was reconnected to his rectum. He had fecal matter, etc. leaking into his abdomon for several days before they did a CT scan to see what was going on. He did eventually recover from the massive infection but he had a lot of complications and has some continuing concerns.
 
We now are now wondering if the leak occurred because he didn't have a catheter and because he was holding back movements that were coming with violent force. I've been researching this and have learned that "leaks" like this are pretty rare, but I can't find any info on the standard course of post-op care, i.e., whether a catheter is routine.
 
It may be that the only thing the catheter would have prevented would have been a great deal of suffering and humiliation (i.e., perhaps its omission didn't cause the leak) but we're pretty sure he would have died without us being there to force them to act when it was apparent he was dying and they were playing hot potato. Regardless, my advice to anybody who is going to be hospitalized at any time for anything (based on several experiences, not just this one) is to research it extensively beforehand so you know what to expect, and to bring bodyguards (friends and family) who have been educated. 
 
Specifically, be sure you understand the worse case scenarios, how to recognize them, and who will be responsible for seeing you through any problems that occur. (That last part may be more important than you might assume.) See this past Sunday's Parade Magazine (insert to many Sunday papers) for the type of things to watch out for.

schrek-chewbacca hunk
Veteran Member


Date Joined Jun 2005
Total Posts : 2666
   Posted 2/17/2009 5:01 PM (GMT -6)   

My question on the rectal catheter was different for the prep as I have charkot disease and I move with great difficulty - so the prep is a bit energetic for my reaction time and I was requesting a rectal catheter to remove the waste before the surgery.  Very different story with me.  sorry.

 

bob


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 2/17/2009 6:24 PM (GMT -6)   

AtHome--did your friend have an abdominal drain?  My cr surgeon always put one in no matter what surgery I had.  It did alert us, once, to an abdominal leak when I started eating after a resection.  Its job is to keep any fluid, that shouldn't be in your abdomen, from becoming an issue.

You friend is very lucky to have people who CARE about him!!

 
 

Chevypower1930
Regular Member


Date Joined Sep 2009
Total Posts : 254
   Posted 8/1/2010 3:23 AM (GMT -6)   
I'm currently in the hospital on day 8 of my recovery of my ileostomy surgery, although I didn't have the one step surgery.. I think I can give some input... and rectal drains, although a pain, work wonders... I without a doubt believe your friend should have had one in straight from surgery as I did... my second day of recovery they got me up out of bed to walk to the rooms door and back, and the drain fell out... they left it out as it was just in to drain the remaining mucus... so the next day they got me up and I started sweating profusely and I blacked out... pulse rate was 208. doctors said it was due to my infection count WAY up. they put the rectal drain back in and all my blood and infection counts when way back down back to normal within the hour! pretty amazing and the drain is still in today as there is still drainage and they don't want to take a risk. also I'm very happy and reassured I have one of the best surgeons in the country who actually did my fathers surgery and gave his life back from this horrible disease 10 years ago.
19 Year Old Male

Diagnosed with Moderate/Severe Ulcerative Colitis May 2008
2 Flair ups (first flair- 2 months/Currently in Second Flair for over a month)

Currently:
- 6 Asacol Pills 2X Daily (12 pills)
- 60.. tapered to 50..tapered to current 40 MG Prednisone
- Align Probiotic 2X Daily

First Remicade infusion was Dec 4th! doing great

UC in UT
Regular Member


Date Joined Jul 2010
Total Posts : 36
   Posted 8/2/2010 1:39 PM (GMT -6)   
Hello AimingforSerenity,

I am so sorry to hear about your friends complication. However, I had the same operation (Ileorectal anastomosis) in April of this year. Two key differences between your friend and me would be A. I did not have a one step - I was given, and still have, a temporary loop ileostomy. B. They did not use a rectal catheter.

I also had a leak at the anastomosis site (where they connected the ileum to the rectum). I was hospitalized for 6 weeks, with recurring abdominal abscesses (9 total) and a host of other issues. However, my situation, although bleak and horrible, was not as severe as your friends as it sounds like sepsis occurred due to the one step surgery allowing waste to enter the blood stream. My problem was not waste, of course, but there are still bacteria in the intestine that leaked from the anastamosis site and created the abdominal abscesses.

The only other thing I know for certain (because my surgeon warned me pre-op and I researched the heck out of it) is that the chances of having an Anastomotic leak following ileorectal anastomosis are much, much higher. My surgeon did not give me an option for a one step surgery due to the severe risk of leaks and would only do the two step with the temp ileostomy - and I am darn glad he did!

This link discusses the findings of leaks in Anastomosis by type. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876987/ . If you scroll down you will see result and a table that shows the leak percentages for all types of anastomosis. Shocking to discover that the mean average of leaks is only 2.7%. However, for Ileorectal Anastomosis the leak percentage is an astounding 23.3%!!!

My leak began to heal and I have had no abscesses for a month. I go in for a Barium Enema (they are so much fun) on Thursday to make sure but they think it has healed.

Not sure if all of that helps but I certainly hope that it does.
"I come from the suburbs. You know the suburbs? It's where they tear out all the trees and name the streets after them." David Lee Roth

Male, Age 40
Diagnosed with Pancolitis, August 2005
Diagnosis changed to Pancolitis not including Sigmoid colon, rectum Jan. 2006
Past drugs: Azathioprine, Asacol, Remicade, Humira, Cimzia, Methotrexate, Prednisone. All had side effects or stopped working.

Currently suffer from drug induced Lupus, Raynaud's, Cryoglbulinemia and mild arthritis - all attributed to use of Remicade.

April 2010: underwent total colectomy with ileorectal anastomosis with temporary loop ileostomy. Awaiting take down.
Current meds: Rowasa enemas, 10mg prednisone/day
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