Postoperative Issues Following Bile Duct Surgery
Dear Doctor,
I would like to consult you regarding my father.
Three years ago, he underwent surgery for early-stage bile duct cancer, during which his gallbladder, pancreas, and part of his stomach were removed.
Recently, he has been experiencing rectal bleeding.
He went to the hospital for an endoscopy, but the cause could not be identified.
Later, during a small bowel endoscopy, a bleeding site was found at the location of the previous surgery.
The doctor mentioned that there is vascular proliferation at the surgical site, but due to the thinness of the bowel wall, they are unable to use electrocautery for fear of significant bleeding.
Additionally, he cannot take medication due to the risk of thrombosis (my father has also had a stroke).
Despite this, the bleeding continues, and he has been going to the hospital for blood transfusions, currently at a frequency of once a week.
I am truly concerned and would like to know if you have any other suggestions.
Thank you very much.
Rongrong, 30~39 year old female. Ask Date: 2021/08/02
Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello, regarding gastrointestinal bleeding, a small bowel endoscopy revealed a bleeding point that could not be controlled, along with issues related to stroke, indicating a more complex condition.
Generally, the treatment for gastrointestinal bleeding aims to stabilize vital signs, which includes fluid therapy, oxygen therapy, blood transfusions, and medication to ensure patient stability.
Special treatments may include endoscopic hemostasis, interventional radiology for embolization, or surgical exploration for hemostasis.
Adjustments should be made based on the patient's clinical condition.
Sometimes, if the patient cannot undergo invasive procedures, treatment may rely solely on medication, and it may not be possible to address every aspect comprehensively.
Adjustments to medication, conservative blood transfusions, and endoscopic treatments may be necessary.
This is for your reference.
Wishing you health and safety! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.
Reply Date: 2021/08/02
More Info
Post-surgery complications after bile duct cancer treatment can be quite complex and challenging, especially in elderly patients with multiple comorbidities. In your father's case, it appears that he is experiencing significant complications following his surgery for bile duct cancer, which included the removal of the gallbladder, pancreas, and part of the stomach. The presence of blood in the stool and the discovery of a bleeding site during the small bowel endoscopy are concerning and indicate that there may be ongoing issues related to the surgical site.
Firstly, it is important to understand that surgical interventions for bile duct cancer can lead to various complications, including but not limited to bleeding, infection, bile leaks, and changes in bowel function. In your father's situation, the bleeding from the surgical site is particularly troubling. The fact that the physician has noted vascular proliferation at the surgical site suggests that there may be abnormal blood vessel formation, which can occur as part of the healing process but can also lead to complications such as bleeding.
Given that your father has a history of stroke and is at risk for blood clots, the management of his bleeding becomes even more complicated. The decision not to use medications that could increase bleeding risk is prudent, but it leaves the challenge of managing the ongoing blood loss. Regular blood transfusions, as you mentioned, are necessary to maintain his hemoglobin levels, but they are not a long-term solution and can lead to other complications, such as iron overload.
In terms of management options, here are a few considerations:
1. Interventional Radiology: If the bleeding is significant and cannot be controlled through endoscopic means, interventional radiology may offer options such as embolization. This procedure involves the selective occlusion of blood vessels that are contributing to the bleeding, which can be done under imaging guidance.
2. Surgical Consultation: If the bleeding persists and is significant, a surgical consultation may be warranted. A surgeon may be able to assess the situation and determine if a surgical intervention is necessary to address the source of the bleeding.
3. Supportive Care: Given your father's age and overall health status, supportive care is critical. This includes managing his nutritional needs, pain control, and ensuring he is as comfortable as possible. Palliative care services can also provide support for symptom management and help improve his quality of life.
4. Monitoring and Follow-Up: Continuous monitoring of his hemoglobin levels and overall health is essential. Regular follow-up with his healthcare team will help to ensure that any changes in his condition are addressed promptly.
5. Multidisciplinary Approach: Engaging a multidisciplinary team, including oncologists, gastroenterologists, surgeons, and palliative care specialists, can provide a comprehensive approach to managing your father's complex medical needs.
In conclusion, your father's situation is indeed complex, and while there may not be a straightforward solution, exploring options such as interventional radiology, surgical evaluation, and supportive care can help manage his symptoms and improve his quality of life. It is crucial to maintain open communication with his healthcare team to ensure that all potential options are considered and that his care is tailored to his specific needs and circumstances.
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