Post-Surgery Complications After Colorectal Cancer Treatment: A Patient's Journey

Postoperative issues following colorectal cancer surgery?

Hello Dr.
Chang,
I would like to consult you regarding my mother.
She underwent surgery for colon cancer (specifically a colectomy) on August 3rd, and it has been nearly a month since the procedure.
The surgeon indicated that the surgery was very successful, and my mother has been diagnosed with stage IIB colon cancer.
Both the PET scan and the pathology report from the biopsy showed no signs of metastasis or lymphatic invasion.
However, she is scheduled to undergo adjuvant chemotherapy as a preventive measure.
Since the surgery, my mother has been experiencing gastrointestinal issues.
She has been able to have bowel movements and pass gas, but she frequently suffers from stomach pain and abdominal discomfort, along with bloating.
At times, the bloating and pain become unbearable, and she only finds relief after passing gas.
However, she often has difficulty passing gas, which can take a long time.
During this period, she has had to visit the emergency room and was hospitalized.
The attending physician mentioned that she had small bowel edema.
While hospitalized, she underwent enemas and was placed on a fasting regimen.
Unfortunately, just 3 to 4 days after being discharged, she experienced severe pain again.
I would like to ask you, Dr.
Chang, why is my mother experiencing these recurring issues, and what can be done to improve her condition?

Awei, 40~49 year old female. Ask Date: 2022/09/01

Dr. Zhang Shuhao reply Surgery

After colon tumor resection surgery, if there is a tendency for bloating and abdominal pain, there are two common scenarios: First, there may be a narrowing at the anastomosis site or temporary swelling post-surgery causing obstruction.
If the surgery was on the right side of the colon, this could lead to the aforementioned issue of small bowel obstruction.
Second, postoperative adhesions can cause impaired intestinal motility, resulting in symptoms of abdominal distension and cramping pain.
Both situations may gradually improve over time, but a minority of individuals may experience persistent symptoms that affect their quality of life.
It is advisable to eat smaller, more frequent meals, increase fluid intake, or enhance the proportion of liquid diet.
Medications to aid digestion and reduce bloating may also be prescribed.
If symptoms improve, adjuvant chemotherapy can be initiated as planned.
If symptoms persist, the physician will arrange for further examinations to clarify whether there is an obstruction, and only in very rare cases would a repeat surgery be necessary.

Reply Date: 2022/09/01

More Info

Post-surgery complications after colorectal cancer treatment can be quite challenging, and it’s essential to understand the potential issues that can arise following such significant procedures. Your mother’s situation, having undergone surgery for stage 2B colon cancer, is not uncommon, and the symptoms she is experiencing—abdominal pain, bloating, and difficulty passing gas—can be attributed to several factors related to the surgery and the healing process.

Firstly, after any abdominal surgery, including colorectal procedures, it is typical for patients to experience some degree of gastrointestinal discomfort. This discomfort can manifest as bloating, gas, and abdominal pain due to several reasons:
1. Postoperative Ileus: This is a temporary condition where the intestines do not function properly after surgery. It can lead to symptoms such as abdominal pain, bloating, and difficulty passing gas or stool. This condition often resolves on its own but can take several days to weeks.

2. Adhesions: After surgery, scar tissue can form, leading to adhesions that may cause bowel obstruction or partial obstruction. This can result in pain, bloating, and changes in bowel habits.

3. Dietary Changes: Post-surgery, patients may need to adjust their diets, which can lead to changes in bowel habits. High-fiber foods, for instance, can sometimes exacerbate bloating if introduced too quickly.

4. Medication Side Effects: Pain medications, particularly opioids, can slow down bowel motility, leading to constipation and discomfort.

5. Psychological Factors: The stress of surgery and the diagnosis of cancer can also affect gastrointestinal function, leading to symptoms like abdominal pain and bloating.

Given your mother’s symptoms of severe abdominal pain and difficulty passing gas, it is crucial to address these issues with her healthcare team. Here are some recommendations that may help improve her condition:
- Follow-Up with a Gastroenterologist: Since your mother has experienced recurrent symptoms, it may be beneficial to consult a gastroenterologist who can perform further evaluations, such as imaging studies or endoscopy, to rule out any complications like strictures or adhesions.

- Dietary Modifications: Encourage her to maintain a balanced diet that is easy on the digestive system. Gradually reintroducing fiber and ensuring adequate hydration can help. Foods that are known to reduce gas, such as bananas, rice, and yogurt, may be beneficial.

- Physical Activity: Gentle physical activity, such as walking, can help stimulate bowel function and reduce bloating.

- Medications: Discuss with her doctor the possibility of using medications to manage symptoms. Antacids, simethicone (for gas), or even laxatives may be appropriate depending on her specific symptoms.

- Pain Management: If her pain is severe, it may require a reassessment of her pain management plan. Sometimes, switching medications or adjusting dosages can provide relief without exacerbating gastrointestinal symptoms.

- Monitoring Symptoms: Keeping a diary of her symptoms, including what she eats and her pain levels, can help her healthcare providers identify patterns and triggers.

In conclusion, while postoperative complications are common, persistent symptoms warrant thorough evaluation and management. It is essential to maintain open communication with her healthcare team to ensure that her recovery is on track and to address any complications that may arise. With appropriate care and attention, many patients can successfully navigate the challenges of recovery after colorectal cancer surgery.

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