A friend had surgery for bowel obstruction and her ileo-cecal value was removed. She is concerned that she may die from the effects of the weight loss and diarrhea she is experiencing. Bile is now finding its way into her intestines. Is that a cause of diarrhea? What can she do? Technical stuff may be included. She has been nurse for 27 years.
REPLY:
There are several possible explanations for diarrhea after surgery. If a very large length of small bowel was removed diarrhea may be the result of this loss with the consequent shortening of the entire GI tract mouth to anus. Even in these unusual cases the body slowly adapts and diarrhea lessens. Diet changes and medications can be helpful. Only in cases of extreme loss of many feet of intestine would one worry about the patient's survival and even here intravenous nutrition may replace deficiencies.
Diarrhea post-op could be due to factors not directly related to the surgical procedure. Some patients develop antibiotic associated diarrhea and stools need to be checked for the toxin to a bacteria called Clostridium difficile. If positive, the situation can be treated with special antibiotics to allow the eventual growth of the bacteria which normally inhabit the large intestine once the C. difficile organisms are eradicated.
The small bowel re-absorbs bile in last section of the small intestine, the ileum, so that in a normal intact GI tract bile is recirculated to the liver in a very efficient closed-loop situation. Bile can come in contact with the large bowel if a sufficient portion of the ileum is diseased or removed. It will act as a laxative and promote watery stools and diarrhea. Even in this case adaptation, the passage of time, and the use of certain medications to bind the bile can be of help. One such drug is cholestyramine resin powder. It can be helpful and very constipating. Other drugs which affect colonic motility such as Lomotil or Imodium can also be used. Some dietary changes may be of benefit until the body adjusts.
Your friend should work with her surgeon, family doctor, and possibly a gastroenterologist to work through the various possibilities. She should do well with the correct treatment of this problem.
--
Bruce Sckolnick, M.D.
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review previous Digestive Clinic consultations