What's happening: Repeated Obstructions Post-Surgery

[Karajan]

Hi folks I had major surgery for adhesive obstructions in February this year. However I keep getting these periodic obstructions I had another last night, this is the fourth since my op. they always start the same I feel very bloated, start to have pain in mid belly my tummy blows up and then the cramping comes and OMG this is horrendous this started at 10pm last night went on till I began vomiting at 5.30 am today then the flooding watery stool this goes on till I am completely empty and then comes the relief. The last one I had I had to go into hospital and they found by CT scan that I was bleeding into the lumen of small bowel but they didn't do anything just kept worrying about my low blood pressure and taking blood tests every couple of hours. I don't have a large bowel as it was removed around 12 years ago for motility issues but pathology said there were granulomas not usual in non crohns patients I was told. It was still a couple of years after that my crohns was diagnosed. I feel so fed up still getting these obstructions approx monthly to every six weeks. I did not go to hospital this time my GP gave me morphine to take at home when this happens providing that when it gets to having to take 2 then I agree to be admitted. I work and this is very difficult to manage. I follow a strict low residue diet, I call it the white diet but even on this one time I could eat white bread and am ok then next time I'm not. Any advice greatly appreciated.

 

[Jennifer]

Are you on any medications? Do you know if its scar tissue that wasn't removed (or could be from the surgery itself) or perhaps its inflammation at the resection site that's causing it? I had a CT that showed thickening at my resection site and it went down after IV steroids in the hospital for a few days (I'm on Entocort now). It would be good to know if you're in a flare and may just need a medication adjustment.

The morphine is nice for pain but be careful about taking anything that may cause constipation.

 

[Karajan]

I am on 175mg azathioprine Jennifer. I don't know if I'm in a flare have had frequent drenching sweats several times a day for a couple of weeks. I also have pain and swelling in left thumb and hip. The main pain and site of surgery is on left hand side I think where the anastomoses is they did balloon dilation about a year ago but still got obstructions 19 times last year and prior to op in February I have had 4 since op. it possibly is more scar tissue but I have clinic in August so will ask about medication. Anyone else have any ideas?

 

[Jennifer]

For now try to eat smaller meals more frequently and try to make sure they are soft and easy to digest. Making your own stews/soups helps. Avoiding anything that will make your stool pass quicker (like fiber) should help with your symptoms as well. I hope you can get this sorted soon because even partial obstructions aren't fun to deal with and can definitely lead to a full obstruction. To me it sounds like not everything was removed during your last surgery that needed to be.

 

[Karajan]

Hi Jennifer thanks for the reply, I saw GP today and he thinks I am flair one so on budesonide, not quite as effective as pred but I will save that for later. Had watery stool 12 times yesterday and still the drenching sweats having to drink gallons as it for once in the uk very warm, has been for 1 week. I am usually very careful with food but for two weeks have been having Special K for breakfast and it seems to be causing grumbling cramps and bloating so that is binned now. Back to rice crispies for me. I have crohns clinic on 20 th August but if this gets any worse will contact IBD nurse. Thanks for your post

 

[Jennifer]

What sort of milk are you using with your cereal? A lot of people seem to have issues with milk/lactose.

 

[Karajan]

I use semi skimmed but only about 50 mls as I am a bit sensitive to lactose and haven't yet found an alternative that doesn't turn my tummy lol