DEAR DR. GOTT:
My wife had a colostomy because of a bowel obstruction in January 2006. She has had a great deal of suffering since it reversed in June 2006.
It seems like she has to go to the emergency room of our local hospital every three or four months because of severe abdominal pain. The pain always comes from the same location, the area where the two sections of intestine were reattached.
During her follow-up visits after the surgeries she was told that because of her persistent pain that she is in the 25% of patients who have chronic pain because of adhesions and scar tissue build-up at the incision site. The excess tissue is also causing parts of the intestine to collapse, leading to periodic blockages and pain that are treated with IV antibiotics and pain medication in the hospital.
Because I hate to see my lovely wife suffering so much, I have done my own research on her situation. I found an article about bowel obstruction on www.WebMD.com and it mentioned something called a stent. I asked her surgeon about this but he said she is not a candidate because she is otherwise healthy and that stents are only used as last resorts for short periods of time in terminally ill patients.
I want to know if this is a correct analysis of the situation. Is it common to use stents only in the terminally ill? It doesn’t seem logical to me that someone dying should be a candidate but not a healthy person.
DEAR READER:
Let me start by saying I am not a surgeon and cannot give more than general information regarding your wife’s situation.
You have kindly included the article and a list of your wife’s surgery from January 2006 to February 2008. She has had a colostomy, colostomy removal, four scar tissue/adhesion removals, and a colonoscopy. I also note that you have included hospital charges for most of the procedures which total up to more than $200,000. I would imagine with the missing charges and the doctor’s fees this easily adds up to more than $300,000 which is more than staggering. However, I will save the healthcare cost rant for another column.
I will start with the reason your wife had the initial surgery: bowel obstruction. A bowel obstruction exists when the intestine becomes twisted, knotted, pinched or otherwise blocked preventing its contents from passing through and leaving the body. Blockages can be complete or partial. Complete blockages can be especially dangerous because of the risk of intestinal rupture due to increasing pressure caused by the backed up fecal matter. If rupture occurs, the contents spill into the abdominal cavity and if left untreated can cause infection, sepsis and death. Partial blockages generally are not as dangerous but must be taken care of immediately to prevent complete obstruction.
Because your wife required surgery, I assume she had a complete blockage. During surgery the blockage is removed and if necessary the intestine is repaired or part of it is removed. A colostomy is put in place to allow proper healing.
Most gastroenterologists place stents in the bowel because of an oncologist’s recommendation. This translates into most individuals who receive bowel stents because they have some form of intestinal cancer. However, given your wife’s continuing difficulties, I recommend you get a second opinion. This will bring a new perspective to the situation and perhaps new treatment options.
Adhesions are painful buildups of scar tissue often at or near a surgical incision. Scar tissue is necessary for proper healing because it joins the two sides of the incision, closing the wound. However, when this process occurs abnormally, too much scar tissue is made and not only closes the wound but also pulls on surrounding healthy tissues adhering them together which often causes pain. Ironically, the only treatment I am aware of is surgery to remove the excess tissue and separate the abnormally joined areas. Some individuals then develop more adhesions from the removal surgery, as is (I assume) the case with your wife.
When you see the second specialist, I urge you to ask about any new treatment options for the adhesion as well, which, if eliminated, may resolve the continuing bowel obstruction problems, too.
To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
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