Postoperative issues following rectal cancer surgery?
Dear Director Ke,
My father was diagnosed with stage I rectal cancer and underwent surgery in early September.
During the diagnostic process for the rectal cancer, he had a colonoscopy, during which two additional polyps were found in the colon besides the lesion.
These polyps were addressed during the colonoscopy.
After the procedure, my father experienced an increase in bowel movements and some bleeding.
The physician indicated that this was a normal occurrence; however, after passing blood in his stool 5-6 times, he experienced brief dizziness.
He received a hemostatic injection, but there seemed to be no improvement, so he underwent further examination.
The physician stated that there was only slight oozing of blood and no significant bleeding points, thus deciding to proceed with surgery the next day to also observe the condition of the polyps.
The following day, after the surgery, the physician reported that everything went smoothly and there was no further bleeding from the polyp site.
After approximately 10 days of hospitalization for observation, the physician deemed him fit for discharge.
The first week at home went well, but after a week, my father experienced blood in his stool again.
When wiping with toilet paper, there were noticeable blood stains, sometimes dark and sometimes bright red.
Concerned, my father returned to the hospital to consult the physician, who reassured him and prescribed hemostatic medication.
However, after a week of taking the medication, there was no improvement.
Upon returning to the hospital, the physician again reassured him, suggesting that his body should heal on its own without further medication.
Due to the persistent blood in his stool, which sometimes occurred 5-6 times a day, we consulted a traditional Chinese medicine physician at the same hospital, hoping to use herbal medicine for adjustment.
After treatment, the frequency of bowel movements decreased to 2-3 times a day.
In early October, there were two days without a bowel movement, but afterward, everything seemed to return to normal without any blood in the stool.
However, after a week, we noticed occasional blood in the stool again, sometimes more severe and sometimes mild, with colors varying between dark red and bright red.
Initially, we thought it might be related to diet, but we couldn't identify any specific patterns.
During a follow-up appointment in late October, the physician did not conduct any examinations regarding this phenomenon and suggested it was caused by hemorrhoids.
Before the surgery, the physician had mentioned that my father had hemorrhoids, but they were not severe.
This has been the situation over the past two months, and I would like to ask Director Ke:
1.
What could be the cause of the persistent blood in the stool? Is this "normal" after surgery?
2.
If this condition continues without improvement, are there any further examinations that should be conducted?
3.
My father mentioned that during the colonoscopy when the polyps were removed, he heard the physicians inform the attending physician that a hemostatic clip had fallen off and could not be found.
The attending physician later stated that there was no need to search for it and that it could be passed out with the stool.
Could this situation be related to the ongoing blood in the stool? Is it acceptable for the hemostatic clip to remain in the body?
I apologize for the lengthy message.
The ups and downs over the past two months have left my parents physically and mentally exhausted, and as their child, I am deeply concerned.
I kindly ask for your guidance and response.
Thank you very much.
Sincerely,
Little Boat
Xiao Chuan, 30~39 year old female. Ask Date: 2013/10/28
Dr. Ke Fangxu reply Surgery
1.
After surgery for rectal cancer or polypectomy, there can indeed be mild bleeding as a complication.
However, if this bleeding persists intermittently for more than a month, it is important to rule out the possibility of complications from the surgery or polypectomy.
The most likely cause is hemorrhoidal bleeding.
If it does not lead to anemia, it is not a major concern, and hemorrhoidal suppositories can be used for treatment.
2.
A very rare possibility is bleeding from the anastomosis site after rectal surgery, which typically involves a larger volume of bleeding.
If an examination is needed, a colonoscopy or angiography may be required, but if the bleeding is not continuous, it may not be detectable.
3.
The size of hemostatic clips is smaller than watermelon seeds, and it is common for them to dislodge and be expelled with stool.
There is no need for excessive concern, as they are not a cause of bleeding.
Reply Date: 2013/10/28
More Info
Dear 小船,
Thank you for reaching out with your concerns regarding your father's post-surgery condition following his rectal cancer operation. I understand how distressing it can be to witness ongoing symptoms, especially after such a significant medical procedure. Let’s address your questions one by one.
1. Persistent Blood in Stool: It is not uncommon for patients to experience some bleeding after rectal surgery, especially if there were additional procedures like polyp removal during a colonoscopy. The presence of blood can be attributed to several factors, including irritation from the surgical site, healing of the mucosal lining, or even the presence of hemorrhoids, which your father’s doctor mentioned. The fact that the blood varies in color—from dark red to bright red—can indicate different sources of bleeding. Darker blood often suggests that the bleeding is coming from higher up in the gastrointestinal tract, while bright red blood typically indicates a more distal source, such as the rectum or anus.
2. Need for Further Investigation: Given that your father has experienced ongoing blood in his stool, it is advisable to have a follow-up examination. While some bleeding can be normal post-surgery, persistent or worsening symptoms warrant further investigation. This could include repeat colonoscopy or imaging studies to ensure there are no complications such as anastomotic leaks, strictures, or other issues that could be contributing to the bleeding. It’s important to communicate these ongoing symptoms to his healthcare provider, who may recommend additional tests.
3. Concerns Regarding the Hemostatic Clip: The incident with the hemostatic clip that was reportedly lost during the polyp removal procedure could potentially be related to the bleeding. While it is generally safe for a clip to pass through the digestive system, if it were to cause irritation or obstruction, it could lead to bleeding. However, if the clip was indeed lost and not causing any immediate complications, it is unlikely to be the sole cause of the persistent blood in the stool. It’s essential to discuss this specific concern with your father’s surgical team, as they can provide more tailored advice based on his surgical findings and overall health status.
In summary, while some bleeding can be expected after rectal surgery, the persistence and variability of your father’s symptoms should be taken seriously. It is crucial to maintain open communication with his healthcare providers and advocate for further evaluation if symptoms do not improve. Your father's well-being is paramount, and ensuring he receives appropriate follow-up care is essential for his recovery.
I hope this information helps clarify your concerns, and I wish your father a smooth recovery. Please do not hesitate to reach out if you have further questions or need additional support.
Best regards,
Doctor Q&A Teams
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