Post-Surgery Challenges for Colorectal Ulcer Patients: A Caregiver's Dilemma

Q: Post-Surgery Challenges for Colorectal Ulcer Patients: A Caregiver's Dilemma

Hello： Typically, an endotracheal tube should be replaced every two weeks at most. <br>If it is used beyond this period, the risk of infection increases, which can reduce the likelihood of successful extubation. <br>Additionally, having the tube in the mouth for an extended perio

Postoperative issues following colorectal ulcer surgery?

Dear Dr.
Yang,
I would like to ask about my grandmother's condition.
She is currently 78 years old and has been suffering from severe herpes zoster (commonly known as shingles) in her abdomen for the past two months, which has led to a loss of appetite.
A month ago, due to her weakness, she was hospitalized for intravenous fluids, and it was discovered that she has diabetes.
After being transferred to a larger hospital, she underwent surgery for peritonitis, during which a perforation in her colon was found, resulting in the removal of a section of her colon.
The doctors mentioned that her intestinal wall is too thin to be reconnected immediately and that it needs time to heal before another anastomosis can be performed.
Consequently, she was admitted to the intensive care unit with an endotracheal tube in place to assist with suctioning.
Within a week, there was an attempt to remove the endotracheal tube, but the nurses indicated that she was still unable to cough up secretions on her own, so the tube was reinserted.
Subsequently, my grandmother developed a fever due to an infection from intestinal waste, leading to two surgical cleanouts (approximately once a week).
During the second cleanout, the doctor advised that the endotracheal tube should not remain in place for too long due to the risk of lung injury and suggested performing a tracheostomy, as it would only require one anesthesia session.
The doctor communicated with the family for a long time, but we strongly opposed the tracheostomy at that time.
This opposition stems from the experiences of two relatives who underwent tracheostomy after strokes; although they survived, they have spent years in nursing homes—one for four years and the other for ten—both still residing in long-term care facilities.
We do not want our grandmother to spend her later years in such a manner.
While financial considerations are one aspect, it is particularly concerning that she previously expressed a desire not to live in a nursing home.
However, seeing my grandmother with the tube in her mouth, which has caused inflammation of her lips and tongue, and last Saturday (after the third surgery) discovering that her mouth was bleeding due to discomfort from biting the tube, the nurses have urged the family to agree to the tracheostomy.
They emphasize that the tube cannot remain in place for too long (it has already been three weeks) and that it could alleviate her suffering.
We find ourselves in a dilemma: on one hand, we fear that if she undergoes a tracheostomy, her wounds may still not heal; if we do not proceed with treatment, it may only prolong her pain.
On the other hand, if her wounds heal and the colon can be reconnected, we are uncertain whether the tracheostomy tube can be removed and if she will be able to breathe and cough independently.
If she cannot breathe or cough on her own, will she have to spend the rest of her life in a nursing home?
I have written so much, and I hope Dr.
Yang can understand my concerns.
Is a tracheostomy absolutely necessary, or are there other options? Additionally, my grandmother's surgical wounds have been healing poorly, and she previously had inflamed tissue scraped away due to infection.
Is this related to her diabetes?
I apologize if I should have consulted a gastroenterologist or a pulmonologist regarding the intubation issue.
If I have made a mistake, I appreciate your understanding.
Could you please help us and save my grandmother? She is my dearest grandmother! Thank you for your kindness and assistance!

Cao Xiaojie, 70~79 year old female. Ask Date: 2003/07/28

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello: Typically, an endotracheal tube should be replaced every two weeks at most.
If it is used beyond this period, the risk of infection increases, which can reduce the likelihood of successful extubation.
Additionally, having the tube in the mouth for an extended period can be uncomfortable for the patient.
The adhesive tape used to secure the tube on the face can cause skin irritation, redness, and ulceration over time, and the lips may develop herpes or sores.
For these reasons, if the patient's condition is not rapidly deteriorating or if successful extubation is not possible in the short term, we usually recommend performing a tracheostomy.
Even with a tracheostomy, if extubation is successful, the tracheostomy site can still heal on its own.
This is the correct recommendation from a medical standpoint.
There are many reasons why wound healing may be poor, with diabetes being a significant factor.
Prolonged inability to eat can lead to malnutrition, and long-term bed rest can cause gastrointestinal motility issues, both of which can hinder wound healing.
Best wishes for health from Dr.
Yang Pei-Chen, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/07/28

More Info

Your grandmother's situation is indeed complex and understandably distressing for you and your family. The challenges she faces post-surgery, especially after a significant procedure like a bowel resection, can be overwhelming. Let's break down the concerns you've raised regarding her care and the potential need for a tracheostomy.

1. Need for Tracheostomy: The recommendation for a tracheostomy often arises when a patient requires prolonged mechanical ventilation or has difficulty clearing secretions. In your grandmother's case, the fact that she has been unable to cough effectively and has had a breathing tube for an extended period raises concerns about potential complications, such as ventilator-associated pneumonia or damage to her vocal cords and trachea. While the idea of a tracheostomy can be daunting, it is generally considered when the benefits outweigh the risks. It can provide a more comfortable and safer way for her to breathe and allow for better oral care, reducing the risk of infections.

2. Concerns About Quality of Life: Your worries about her quality of life post-tracheostomy are valid, especially considering the experiences of your relatives. However, it’s essential to understand that each case is unique. Many patients who undergo tracheostomy can eventually wean off the ventilator and regain their ability to breathe independently. The goal of the procedure is to improve her comfort and overall health status, not to prolong suffering.

3. Wound Healing and Diabetes: Diabetes can significantly impact wound healing due to factors like poor circulation and immune response. If your grandmother's surgical site is not healing well, it could be related to her diabetes, especially if her blood sugar levels are not well controlled. It’s crucial to manage her diabetes effectively, as this can improve her healing process and overall recovery.

4. Communication with Healthcare Providers: It’s vital to maintain open communication with her healthcare team. Express your concerns and ask for detailed explanations about the necessity of a tracheostomy, the risks involved, and what the recovery process might look like. Understanding the rationale behind their recommendations can help you make a more informed decision.

5. Alternative Options: If you and your family are still hesitant about the tracheostomy, discuss alternative options with her medical team. They may be able to provide other solutions for managing her breathing difficulties and secretions, although these may not be as effective in the long term.

6. Emotional Support: This is a challenging time for both your grandmother and your family. Consider seeking support from social workers or counselors who specialize in healthcare settings. They can provide guidance and emotional support for you and your family as you navigate these difficult decisions.

In conclusion, while the decision regarding a tracheostomy is significant, it is often made with the patient's best interests in mind. The goal is to enhance her quality of life and ensure her comfort during recovery. It’s essential to weigh the potential benefits against your fears and to have thorough discussions with her healthcare providers to explore all possible options. Your grandmother's health and comfort should be the priority, and with the right support and management, there is hope for improvement in her condition.

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