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Have Piles. Had Severe Intestinal Distension Due To Constipation. Feeling Dizziness And Fatigued. Further Examination Required?
Question: Dear Sir , my mother, 68, had sever intestinal distension due to constipation. She has piles, but is not diabetic.
She had a laparotomy to remove excess fecal matter, but surgoens found nothing else in there, and put it down to XXXXXX syndrome. Now she has fatigue, dizziness, cold hands and feet, feels cold in her tummy (inside), and is forgetful. She also has pains in the tummy occasionally,and a frequent rumbling sound in the stomach. She has edema in her feet, am not sure which sort, but the finger imprints on the skin do not cause permamnent marks. Thyroid reports are normal
Do we need a further examination?
She had a laparotomy to remove excess fecal matter, but surgoens found nothing else in there, and put it down to XXXXXX syndrome. Now she has fatigue, dizziness, cold hands and feet, feels cold in her tummy (inside), and is forgetful. She also has pains in the tummy occasionally,and a frequent rumbling sound in the stomach. She has edema in her feet, am not sure which sort, but the finger imprints on the skin do not cause permamnent marks. Thyroid reports are normal
Do we need a further examination?
Hi,
Thanks for writing in XXXXXXX
A laparotomy for colonic pseudo obstruction (Ogilvie's syndrome) is indicated in a very low percentage of cases. It is usually senn in bedriden patients who are on psychotropic medications or otherwise who ususlly are chronically habituated to the use of laxatives.
Was a CT scan done prior to the laparotomy. If it was done and did not reveal any cause for obstruction then a good conservative management and supportive care is essential. I would suggest the following now.
1. Adequate hydration either IV or oral to ensure good urine output.
2. Monitoring of serum electrolytes namely Na, K and Cl. Electrolyte imbalance can cause problems with bowel motility.
3. If she still has problems with bowel movement then a mild stool softner is essential.
4. Vitamin supplements preferably parenterally . ( A course of Neurobion injections.)
5. Medications having trophic effect on the gut such as Glutamine supplements by IV route will also help.
6. Early ambulation that is she should get up and start moving.
7. Diet should be soft with good fiber contents. Avoid constipating foods.
8. If the protein content of her body is low then albumin infusions will help significantly.
I hope my advice provides you with a yard stick for further treatment of your mother.
If you have any further querries please write to me.
With regards
Thanks for writing in XXXXXXX
A laparotomy for colonic pseudo obstruction (Ogilvie's syndrome) is indicated in a very low percentage of cases. It is usually senn in bedriden patients who are on psychotropic medications or otherwise who ususlly are chronically habituated to the use of laxatives.
Was a CT scan done prior to the laparotomy. If it was done and did not reveal any cause for obstruction then a good conservative management and supportive care is essential. I would suggest the following now.
1. Adequate hydration either IV or oral to ensure good urine output.
2. Monitoring of serum electrolytes namely Na, K and Cl. Electrolyte imbalance can cause problems with bowel motility.
3. If she still has problems with bowel movement then a mild stool softner is essential.
4. Vitamin supplements preferably parenterally . ( A course of Neurobion injections.)
5. Medications having trophic effect on the gut such as Glutamine supplements by IV route will also help.
6. Early ambulation that is she should get up and start moving.
7. Diet should be soft with good fiber contents. Avoid constipating foods.
8. If the protein content of her body is low then albumin infusions will help significantly.
I hope my advice provides you with a yard stick for further treatment of your mother.
If you have any further querries please write to me.
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir
The surgeons ordered an xray before surgery which showed the intestines having inflated to the level of the heart. No CT scan or sonography was done pre or post. However the surgeons inform me that they found no obstruction/tumor intra-operatively.
Please suggest, in view of the bowel rumbling/fatigue etc, if internal bleeding or bowel perforation is a possibility, and if so, whether we should get any tests done. (What I really want to ask is whether there is still any cause to worry). She had hypokalemia (1.9) 4 days after surgery, but this was corrected aggresively. Recent (4-5 days ago) checks show normal BP
The surgeons ordered an xray before surgery which showed the intestines having inflated to the level of the heart. No CT scan or sonography was done pre or post. However the surgeons inform me that they found no obstruction/tumor intra-operatively.
Please suggest, in view of the bowel rumbling/fatigue etc, if internal bleeding or bowel perforation is a possibility, and if so, whether we should get any tests done. (What I really want to ask is whether there is still any cause to worry). She had hypokalemia (1.9) 4 days after surgery, but this was corrected aggresively. Recent (4-5 days ago) checks show normal BP
Hi,
Thanks for the feedback.
Internal bleeding will manifest as passage of either XXXXXX blood in the stools or passage of black tarry stools. If these two symtoms are absent then that rules out XXXXXXX bleeding.
Regarding perforation , a proper clinical examination of the abdomen will either help to detect or rule out perforation of the large gut.
I would like to know if any stoma was created in view of such a massively dilated colon.That would have made life comfortable for the patient and the patient's abdominal condition would have improved dramatically post operatively.
The fatigue could be due to various causes
a. low hemoglobin.
b. low albumin/protein levels
c. electrolyte imbalance that is low K and Na.
d. ileus due to slowing of the gut.
I would also like to know as to what is the present condition of the patient. Is she still admitted? and if yes what treatment is being administered. I would be in a better position to help your mother if you could call me on my mobile as displayed on the website (0000)
With regards
Thanks for the feedback.
Internal bleeding will manifest as passage of either XXXXXX blood in the stools or passage of black tarry stools. If these two symtoms are absent then that rules out XXXXXXX bleeding.
Regarding perforation , a proper clinical examination of the abdomen will either help to detect or rule out perforation of the large gut.
I would like to know if any stoma was created in view of such a massively dilated colon.That would have made life comfortable for the patient and the patient's abdominal condition would have improved dramatically post operatively.
The fatigue could be due to various causes
a. low hemoglobin.
b. low albumin/protein levels
c. electrolyte imbalance that is low K and Na.
d. ileus due to slowing of the gut.
I would also like to know as to what is the present condition of the patient. Is she still admitted? and if yes what treatment is being administered. I would be in a better position to help your mother if you could call me on my mobile as displayed on the website (0000)
With regards
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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