Potential Problems Following IBD Surgeries
With any type of bowel surgery, there are always risks. The following are potential problems following surgeries.
Bowel blockage or stoppage of the bowel can happen following surgery. The signs of a bowel blockage would include no stool or gas being passed, abdominal distention or fullness, nausea and vomiting. Treatment is most often conservative. Time, nothing by mouth, intravenous fluid and walking are all important measures that can help to alleviate the blockage. Blockage can occur later in the recovery process and treatment would essentially be the same. The important thing to remember following surgery is early and frequent movement.
Bladder and wound infections may occur. Antibiotics given before and during surgery greatly reduce these risks.
Blood clots are relatively rare. Heparin or blood thinner is given by injection twice a day until discharge to minimize this occurrence. Early movement is the key to avoid clots.
Chest infection or pneumonia is also considered a potential problem. Deep breathing and coughing exercises are encouraged, as well as early movement to prevent this problem.
Leaks at the anastamosis (join) of the pelvic pouch to the anus can occur but are not common. The anastamosis is protected with either a loop ileostomy or rectal tube depending on the surgical scenario. If the loop ileostomy is present, a pouchogram or X-ray of the internal pouch is done prior to the ileostomy closure to ensure that healing has occurred and no leak exists.
Impotency or inability to achieve an erection can occur. The small microscopic nerves that surround the rectum can not always be identified when the rectum is removed. This may lead to impotence in an extremely small percentage of patients. In the pelvic pouch operation, the risk is one to two per cent. The risk of impotency is somewhat higher in cancer surgeries involving the rectum. Ejaculation problems can occur in approximately three to four per cent of those males that are operated for ulcerative colitis.
When the rectum is left in place, as is the case with a subtotal colectomy, there is always the risk of disease becoming active within the "rectal stump". Signs of disease activity includes: increased bloody drainage, vague low abdominal pain or cramps and a general unwell feeling. Treatment includes steroid suppositories or enemas. This problem is overcome when the rectum is actually removed by either doing a complete protectomy with a permanent ileostomy or a reconstructive procedure in the form of the Pelvic Pouch.