Bleeding after surgery

My daughter, M, had resection surgery one week ago (June 6th). Four days after surgery she was allowed full solids. Four days after full solids she began to pass blood in her stools. It's bright red, not a lot, and she has stinging after the poop just inside the end of her colon. Her poops are formed and regular colored.

Other background info: she was dx'd w/Crohn's in April this year by imaging alone. She had abscess, fistula and phlegmon. She was very sick and stayed in the hospital for 10 days. She was put on TPN and IV zosyn. Four weeks later we were allowed to reintroduce foods. First she tried NG tube and EN feedings that didn't work, then we tried low residue/SCD diet and that didn't work b/c of stricture that cause full obstruction. She went back into hospital and we then agreed w/the team of doctors that surgery would be best. She went back on TPN and zosyn to cool things down and just completed surgery.

Surgery went well. They removed a few inches from terminal ileum. Pathologoy came back yesterday which labeled it ileitis and stricture. She is on a tapering dose of pred/7mg until our follow up appointment the first week in July.

The bleeding she is having now is similar to the bleeding she had before diagnosis. I am planning to call the GI doc on Monday morning. I called them Fri afternoon and their advice to me was monitor the bleeding. If it gets worse, go to ER and if it stays the same call on Mon. So far, it's the same. I'm not alarmed but I'm worried.

I'd like to know what kind of questions you suggest I bring to the doctor on Monday.

TY!

Good to hear the surgery went well greypup.

From what you are describing it sounds like she may have a haemorrhoid or tear. Either one can cause bright red blood and although both cause pain a tear/fissure will often cause the pain after passing the stool.

What did they say caused the bleeding before and was it bright blood?

Dusty. xxx

The bright red blood indicates the rectum. Do you know if her crohn's was also located their?
She could have fissures (sp?). Have the suggested putting her on a stool softener?
Has she still not been scoped? I see it in your sig..

I'm glad her surgery went well.

They haven't been able to scope her ever b/c she was too high risk w/the previous complications. So they haven't ever told us what the bleeding might be. We do know that she has a fissure on her bottom outside. I suppose it could start inside and end outside?

If it is hemorroid or fissure, does this mean the disease is in a flare? How do we get either one under control?

So far, all that we know is she the crohn's is located in small intestine where they removed the section. She does have a skin tag and fissure they have id'd by visual exam.

greypup said:

If it is hemorroid or fissure, does this mean the disease is in a flare? How do we get either one under control?

Click to expand...

Not necessarily, particularly when it was present prior to surgery.

Hopefully surgery will induce immediate remission, as it does for many people, my two included, but it will take time for existing issues to heal and that time may be extended a little due to the Prednisone.

If all the diseased bowel has been removed then the inflammation is also removed. That in itself will induce healing as the root cause of the problem has been removed. In the interim though I would ask the GI is there is something to help alleviate the problem.

At home you can do sitz baths to keep the area clean and help to heal the fissure. Calmoseptine cream is also very good at providing relief and protection. Use it sparingly and remove it completely before reapplying.

Dusty. xxx

DustyKat, thank you for your recommendations.

She can't have a bath yet b/c the incision isn't healed yet. But I will keep this in mind for future.

Is the cream a prescription or OTC?

You can do sitz baths by just sitting your bottom in a basin/bowl. Also drying the area with the low setting on a hairdryer is good too.

It is OTC. Another good cream is Ungvita (not sure if that is available in the US though) or PawPaw. They aren't barrier creams but are good at healing superficial wounds, like fissures.

Dusty.

Hugs
I would agree with the fissure or rectal inflammation.
DS has rectal inflammation.
He uses canasa suppositories to help with the localized inflammation in addition to humira.
He describe the pain the same as your daughter.

The canasa is a bandaid though according to our Gi
It stops the bleeding but we increased his humira and will use canasa until the higher dose has a chance to work.

I would ask the Gi what the plan for maintence meds are?
6-mp or Imuran or biologics ?
All take time to work and should be on board before a pred wean ideally to stop another flare.
When the scope will be done?
Will there be fecal caloprotectin testing ? How often?

Good luck

DustyKat, thanks for the info. I will ask M if she wants to try a sitz bath and look for the creams as well.

My Little Penguin, we are waiting for four week follow up to learn about maintenance meds and colonoscopy date. I will ask about fecal caloprotectin testing too.

In the meantime, we have had an appointment scheduled, 6/24, at Mayo Clinic. I think the time to go is now to compare opinions on maintenance. Has anyone else used Mayo?

I will tag crohnsmom
She has taken her daughter there
I think they only treat adults though .
It depends on location
Mayo is a wonderful idea though .

Rochester MN has a ped GI unit. When M was first dx'd in April, I Fed Ex'd her records and they called the next day to begin scheduling.

Unfortunately, because of different complications she has had I've needed to reschedule the visit 3 times.

I've been pretty impressed by their prompt attn. I've also read that their Ped GI division is top notch.

You are unquestionably on top of it Greypup! Good luck!

thank you, Mark. this is w/out a doubt one of the most challenging, complicated and, sometimes, painful situation we are all in together.

Your greypup is a greyhound??

yes. do you have a grey also?

Don't ask Dex, he will say he lives in a pound! :lol:

Ha! Can't wait to see Dex's reply!

No greys. A Pyrenees, chihuahua, jack russell, min pin/chihuahua mix, and a mutt that just decided this would be a good place to live!...and that's just the dogs!

That's A LOT of love in your house. They know your family is where they belong!

Cody, our grey, was diagnosed w/diabetes 5 years ago. Insulin and all. We also have a mixed breed who is quite loved around here.

Do you have a trusted someone who will watch over everyone while you travel? That's the hardest part...

Hah! Grey, my wife's a vet. No way I could handle all that "love" w/o that little fact!. Did I mention that's only the canine love...we've also 3 cats, 2 horses, a cow and counting roosters, chicks and pullets, 38 chickens!! Oh, and lest I should forget, we also have two Australian Zebra finches that never, ever shut-up!! Go figure!

Oh, can't you just feel the love all the way over in MO!

A cow??????????

We'll I'll be! A cow for a pet??? I'm telling my hubby that some people like cows.
:lol2:

Feeling the love over here!!! ;-) !!!

Happy Father's Day! May you get out of the house for a little R&R today ;-)

Hey FW and Tesscorm...just drop your puppies on Dex's doorstep...that won't notice!

I'd take Tess' Pointer, quail are making a comeback! I don't know what kind of trouble FW's got but I'll pass!