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Help re coffee ground emesis

My husband has ileostomy, Crohn's disease for 30+ years. Has blockages approximately once every couple of years. Yesterday he had blockage & was taken by ambulance to ER (at 64 he's too old to wait it out anymore). During the ER visit, he vomited at least a GALLON of black coffee ground emesis, his abdomen was distended (he looked pregnant), and was having 8/10 pain. At this point no one had even examined him yet, once they saw this humongous amount of black emesis all over the floor, the gurney, etc., they were clearly alarmed and came running into the room. Immediately drew blood, hooked to vitals monitor, ordered an abdominal x-ray, injection of morphine and antinausea med, inserted nasogastric tube, and told me they were sending him up to the intensive care unit. Another 400 cc of black emptied into the nasogastric container. They eventually decided he had to be transferred to a nearby hospital due to insurance issues.
By the time he arrived at the other hospital (6 hrs had passed since vomiting the coffee ground stuff), the nasogastric container had very little in it.
This morning a GI doc performed an EGD. He said it looked fine. Husband's blood counts are good. They will release him today.
My question: I asked the GI doc about the large amount of black coffee ground emesis, where could it be coming from? He replied that it was a "very small amount", I said I was referring to the amount from the first ER which was at least a gallon and another 400 cc thru nasogastric tube. He didn't believe me, said it wasn't possible with his blood counts being normal and EGD looked good.
DO WE NEED TO SEE A DIFFERENT GI DOCTOR FOR A 2ND OPINION, IS THIS POSSIBLE THAT EVERYTHING IS "OKAY" AFTER VOMITING SO MUCH COFFEE GROUND EMESIS ????? It doesn't sound right to me. Doesn't an EGD only cover the UPPER intestinal tract, what about lower tract?
Any advice you can give would be appreciated.
 

DustyKat

Super Moderator
Hi cc1968 and :welcome:

My goodness, what an awful time for you and your husband! :hug:

An EGD will only view as far as the duodenum, so from there to the ileostomy is unseen.

With that amount of coffee ground emesis I would definitely be seeking further advice. Something has caused it and if it were me I would like to know what.

Is his disease under control?

Is he having normal output?

Is he taking any medications, Crohn's related and otherwise?

Under normal circumstances coffee ground emesis would only originate from the stomach as bleeding past this point would pass via the rectum or a stoma. But if an obstruction is present it will bring bowel contents back up through the stomach.

How is he now?

Dusty. xxx
 
Thank you for responding Dusty.
His Crohns has been under control for years with diet, he gets obstructions maybe once every 2 years from eating something that he shouldn't. He realized he had an obstruction about 8pm thurs nite, taken to hospital 8am Fri morning. Normally when this occurs, the force or spasm from vomiting will dislodge the piece of food that is causing the blockage. However, he has never in all these years vomited coffee ground emesis until yesterday. The blockage resolved last nite and they're currently giving him liquids and if he tolerates it, will send him home this evening or tomorrow.
Either this GI doc did not review records sent from the first ER to verify that he in fact had an excessive amount of emesis, or records were not sent when they transferred him to the 2nd hospital.
In any case, I believe all I can do is request records from the first ER and hope they documented it, then find another GI doctor for full evaluation. It just infuriates me that this GI doc is unwillingly to listen and actually said "it's not possible" for him to have vomited a gallon of black coffe ground emesis since his blood count is normal. I don't understand it myself, but I know what I saw! In fact, the GI didn't believe there could be even 400 cc in the NG container either (I actually have a pic of it that I took with my cell phone, maybe I should SHOW him) !!!
 

DustyKat

Super Moderator
That is the thing. Obstruction shouldn't necessarily equate with bleeding and your husband's history supports that. This is not normal for him therefore should be investigated on those grounds alone.

As to the bloods, for some people not everything that person experiences is reflected in their blood results. I have had this experience with my daughter and am once bitten twice shy by it. My own rule of thumb is...if the results don't match what I am seeing in front of me then I don't believe them. The thing is, your husband had a large coffee grounds emesis, the blood results don't change that. I know the second doctor didn't see that but based on what you have told them they should at least try to verify what happened at the first hospital.

I would show him the pic. You do what ya gotta do! :)

Dusty. xxx
 
Here is the thing. And EGD only looks at the stomach and duodenum. It cannot see the small intestines at all. I would probably see if the doctor could order a test to look at his entire small bowel. I just had a test called an MRE of the small intestines. It is suppose to be one of the better tests when looking at the small bowel.

One thing I have found is that you have to advocate for yourself or in this case for your hubby. When that doctor said it was impossible that your hubby could not throw up that amount, I would have told him to call the other ER and find out for himself. That is awful of that doctor to basically call you a liar. I mean you were there, you saw it!! I would be concerned as well. Here is the thing, it may not show up in his blood. I mean likely he did not loose a ton of blood otherwise that would have shown up in his hemoglobin on the blood test. But it still does not explain the amount of vomiting. I would think they should be wanting to look at his small bowel( as I am guessing this is where he has his obstuctions right?) Yeah, I would probably get a different opinion from a different GI if the one you have is not listening to you.... Sorry your hubby is going through all this...
 
Thank you for validating that we should insist on an answer. It's so frustrating. I've learned thru my own experience (2-year breast cancer survivor) that you have to be your own advocate and if you don't get the answers you need, press on until you do. I shall exercise that right regarding my husband's situation. You're right, that GI doctor did call me a liar, without actually saying those words. Now I'm getting angry!

In thinking back on his history, I recalled an incident that happened probably 6 years ago. He had been feeling dizzy & weak for a few days, then actually passed out. I took him to the VA Hospital (where he used to receive all of his care), his blood work showed his hematocrit was 7. They transfused 2 units of blood. A doctor did some type of test thru his stoma (I believe) with a tube. I don't remember what the results were, but I know there was no other treatment besides the blood transfusion. Is it possible he has a very SLOW bleed somewhere in the lower intestines, and this episode of emesis brought up all that old blood?

THANK YOU for your support. This is a wonderful forum, so glad I found it.
Is there a thread for good GI docs on this forum?
 

DustyKat

Super Moderator
It is possible that he has bleed somewhere between his stoma and stomach and this could result in the type of emesis had. It is also possible to scope for a limited distance through a stoma.

When was the last time he had any sort of scoping and/or imaging done?

Dusty. xxx
 

DustyKat

Super Moderator
Oh, finding doctors...

Go to the blue tool bar at the top of this page and scanning from left to right the third last option is the Doctor Directory. When you click on it will bring up a map, choose your country, I assume you are in the US?, and a drop down menu with appear with each state and the reviews that have been done.

You can also go to your local support group, located below the members forum at the bottom of the page, and ask there for any recommendations.

Dusty. :)
 
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