Managing Post-Surgery Abdominal Pain After Colorectal Cancer Treatment

Q: Managing Post-Surgery Abdominal Pain After Colorectal Cancer Treatment

Hello： In response to your question. <br>You are truly a devoted daughter. <br>Based on your description, it seems that your father has rectal cancer and underwent preoperative radiation therapy followed by chemotherapy before the surgical resection. <br>Generally, patients who r

What should I do if I experience abdominal pain after colorectal cancer surgery?

I would like to consult the attending physician in the colorectal surgery department at your hospital.
My father has progressed from stage III to stage IV rectal cancer.
He has been receiving radiation and chemotherapy at Kaohsiung Medical University Hospital.
Later, the doctor recommended surgery for tumor resection.
After the surgery, when he was discharged and returned home, my father frequently experienced severe abdominal pain, to the point where he would cry out in pain and could not eat.
He later returned to Kaohsiung Medical University Hospital's emergency department.
Initially, he was hospitalized and underwent an enema on the third day, which helped him have a bowel movement.
However, it has now been two weeks without any bowel movements or passing gas, and he is unable to eat.
His abdomen is often distended and feels bloated.

I would like to ask the physician about my father's condition.
How long might this last? What could be the underlying cause? He has undergone several X-rays, and the doctor mentioned that his intestines are still obstructed.
What should we do? Since my father cannot eat, he continues to experience abdominal pain.
Please, doctor, help my father.
He is the emotional support of our family, and he cannot afford to be unwell.
I sincerely request your assistance in resolving his abdominal bloating issue, hoping that he can recover his health soon.
Please help my father.
I come from Kaohsiung.

Yifang, 20~29 year old female. Ask Date: 2007/08/18

Dr. Ke Fangxu reply Surgery

Hello: In response to your question.
You are truly a devoted daughter.
Based on your description, it seems that your father has rectal cancer and underwent preoperative radiation therapy followed by chemotherapy before the surgical resection.
Generally, patients who receive radiation therapy have tumors located within 15 centimeters of the anal opening, which makes surgical resection more challenging.
Typically, a protective colostomy is performed in such cases.
I'm curious if your father has a colostomy in his abdomen?
Postoperatively, abdominal distension and the absence of gas can be attributed to two possibilities: one is electrolyte imbalance leading to slow intestinal motility, and the other is intestinal adhesions or volvulus causing obstruction.
The former is more common in elderly patients, as postoperative dietary imbalances can result in low potassium or sodium levels; however, this condition usually does not lead to significant abdominal pain and gas may still be passed.
The latter, on the other hand, typically occurs more than a month after surgery and is less likely to present immediately upon discharge.
Based on your description, the latter possibility seems more likely.
If the former situation is the case, hospitalization may be necessary to correct the electrolyte levels in the blood.
For the latter, management depends on the severity; mild cases may only require a few days of fasting in the hospital until bowel function resumes, while more severe cases might necessitate another surgery to address the adhesions.
If it is convenient for you to visit Kaohsiung Veterans General Hospital, there is a physician named Dr.
Jian Li-Jian, who is my classmate, and it might be beneficial to consult him for further advice, as it is difficult to make a diagnosis without seeing the patient and the X-rays.
Wishing your father a speedy recovery.

Reply Date: 2007/08/18

More Info

Managing post-surgery abdominal pain after colorectal cancer treatment can be a complex issue, especially for patients who have undergone significant interventions such as surgery, chemotherapy, and radiation therapy. Your father's situation, as you described, involves severe abdominal pain, inability to pass gas or stool, and significant discomfort, which can be distressing not only for him but also for the family.

Firstly, it is important to understand that post-operative abdominal pain is relatively common after major surgeries, including those for colorectal cancer. This pain can arise from several factors, including surgical trauma, inflammation, and changes in bowel function. After surgery, the intestines may take time to resume normal motility, which can lead to symptoms such as bloating, cramping, and constipation.

In your father's case, the fact that he has not been able to pass gas or stool for two weeks is concerning and suggests a potential bowel obstruction. This can occur due to various reasons, including adhesions (scar tissue that can form after surgery), electrolyte imbalances, or even the effects of previous chemotherapy and radiation treatments. The pain he is experiencing could be a result of the obstruction, as the intestines can become distended and inflamed, leading to significant discomfort.

Given the severity of your father's symptoms, it is crucial to seek immediate medical attention. If he has already been evaluated in the emergency department and continues to experience these issues, it may be necessary for him to be re-admitted for further evaluation and management. This could include imaging studies such as a CT scan to assess for any obstructions or complications that may not have been evident on previous X-rays.

Management of bowel obstruction may involve several approaches. In some cases, conservative management with bowel rest (no oral intake), intravenous fluids, and possibly nasogastric tube decompression may be sufficient to relieve the obstruction. However, if there is a significant blockage or if the bowel is at risk of perforation, surgical intervention may be required to correct the issue.

In addition to addressing the obstruction, pain management is also a critical component of care. Opioids may be necessary to control severe pain, but they can also contribute to constipation, which complicates the situation. Therefore, a careful balance must be struck between managing pain and promoting bowel function. Medications such as stool softeners or laxatives may be prescribed to help alleviate constipation once the obstruction is resolved.

Furthermore, dietary modifications can play a role in recovery. Once your father is able to resume oral intake, a diet that is low in fiber and easy to digest may be recommended initially, gradually transitioning to a more regular diet as tolerated. Small, frequent meals can also help reduce the burden on the digestive system.

Lastly, emotional and psychological support is essential during this challenging time. The stress of dealing with cancer and its treatment can take a toll on both the patient and their family. Engaging with support groups or counseling services can provide additional coping mechanisms and emotional relief.

In summary, your father's symptoms warrant urgent medical evaluation to determine the underlying cause and appropriate management. It is essential to address both the physical and emotional aspects of his care to ensure the best possible outcome. Please continue to advocate for his health and seek the necessary medical interventions to help him through this difficult time.

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