Post-Duodenal Bleeding: Addressing Concerns After Hospital Discharge

Duodenal bleeding: Issues after hemostasis?

Hello doctor, on February 17th, I was diagnosed with a duodenal ulcer with bleeding after passing a large amount of bloody stool (dark purple color) and was hospitalized for about four days.
During my stay, I did not eat anything due to being on IV fluids.
On the morning of February 18th, I passed a small amount of black stool and then did not have any bowel movements afterward.
On February 20th, I underwent an endoscopy, and it was confirmed that the bleeding in the duodenum had stopped.
That evening, I was discharged to rest at home and started taking my medications (magnesium oxide, Gascon, Tunin, and Naisan tablets) and began eating light foods such as porridge and steamed eggs.
For dinner on February 21st, I added a bit of minced tilapia and cabbage to my porridge.
This morning, I passed some loose black stool and then started passing gas, which has a very foul odor, causing me some concern.
The same foul-smelling gas was present during my initial episodes of bloody stool before I went to the hospital.
Could you please explain why this is happening? Additional information: Prior to passing the bloody stool, I experienced some constipation.
Additionally, due to severe anemia, I received three blood transfusions during my hospitalization.
After the diagnosis of the duodenal bleeding, I still had mild anemia symptoms but did not receive any further transfusions before being discharged to rest at home.

Chen Qian, 10~19 year old female. Ask Date: 2012/02/22

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr./Ms.
Chen,
After duodenal bleeding, sometimes the old blood may gradually be expelled, and its odor and appearance can be similar to that during the bleeding.
If there is a persistent presence of black stools, it is important to be concerned about the possibility of ongoing bleeding.
Additionally, duodenal ulcer bleeding may be related to Helicobacter pylori infection, so it is advisable to return to the hospital for an evaluation regarding the presence of H.
pylori infection.

Furthermore, if anemia is present but hemoglobin levels are not below 8 g/dL and there are no cardiac or pulmonary issues, continuous blood transfusions to reach normal levels are not recommended.
It is important to rest, as hemoglobin levels will gradually return to normal over 2-3 months.

Thank you for your inquiry.

Sincerely,
Dr.
Shih-Tien Chen
Changhua Hospital

Reply Date: 2012/02/22

More Info

After experiencing duodenal bleeding and undergoing treatment, it is understandable to have concerns about your recovery and any ongoing symptoms. The presence of black, loose stools and foul-smelling gas can be alarming, especially after a significant medical event like a bleeding ulcer. Here’s a breakdown of what might be happening and what steps you can take moving forward.

Understanding Your Symptoms
1. Black Stools: The black color of your stools, known as melena, typically indicates that there is still some bleeding in the upper gastrointestinal tract. However, since you mentioned that the bleeding has stopped and you have been discharged after the endoscopy, the black stools could also be a result of the iron supplements or medications you are taking, which can darken the stool. Additionally, the presence of black stools after consuming certain foods, especially those high in iron or dark pigments, can also contribute to this.

2. Foul-Smelling Gas: The odor of your gas can be attributed to several factors. After a period of fasting and then reintroducing food, your digestive system may be adjusting to the new diet. Foods that are high in sulfur, such as cruciferous vegetables (like cabbage), can lead to particularly foul-smelling gas. Furthermore, if your intestines are not fully absorbing nutrients due to the recent ulcer, this could lead to fermentation of undigested food, resulting in gas production.

3. Constipation and Diet: You mentioned having some constipation prior to your hospitalization. This could have contributed to your gastrointestinal issues. After a significant event like a bleeding ulcer, it’s crucial to maintain a diet that promotes regular bowel movements. Incorporating fiber-rich foods, staying hydrated, and possibly using a stool softener or mild laxative (after consulting your doctor) can help alleviate constipation.

Recommendations for Recovery
1. Dietary Adjustments: Continue with a bland diet initially, gradually reintroducing other foods. Focus on easily digestible foods and avoid those that are known to cause gas, such as beans, carbonated drinks, and certain vegetables. Keep a food diary to help identify any specific foods that may be causing discomfort.

2. Hydration: Ensure you are drinking plenty of fluids. This is especially important after experiencing blood loss and to help with digestion and prevent constipation.

3. Monitoring Symptoms: Keep a close eye on your symptoms. If the black stools persist for more than a few days or if you notice any fresh blood in your stools, it’s essential to contact your healthcare provider immediately. Additionally, if you experience increased abdominal pain, fever, or any other concerning symptoms, seek medical attention.

4. Follow-Up Care: Make sure to attend any scheduled follow-up appointments with your healthcare provider. They may want to monitor your hemoglobin levels and overall recovery, especially since you mentioned experiencing mild anemia.

5. Medication Review: Discuss your current medications with your doctor, particularly if you are experiencing side effects. They may adjust your medications or suggest alternatives that are easier on your digestive system.

Conclusion
It’s crucial to remain vigilant about your recovery after such a significant health event. While some gastrointestinal symptoms can be normal during recovery, persistent or worsening symptoms should not be ignored. Open communication with your healthcare provider is key to ensuring a smooth recovery process. Remember to take care of yourself, and don’t hesitate to reach out for help if you have concerns about your health.

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