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how long for peristalsis to correct after bowel surgery

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    how long for peristalsis to correct after bowel surgery

    #1 Anthony had a small bowel obstruction where there was adhesion from an old J tube and his bowel had looped around it so they removed the scar tissue and a small hole in where the bowel was attached was sewn up. The surgery went well. However it is taking a long time for his bowels to wake up. He has had an NG tube in since prior surgery. His surgery was on Feb 5 so 10 days ago. He finally had a liquid stool bm on 2/12 and bile from the NG tube had diminished and they took the NG tube out on 2/13. that eve his stomach got distended so they had to put the NG tube back in and a lot of bile is still coming out. The surgeon said that for a person who is not paralyzed they usually get their bowels working again in 3-5 days after surgery and of course Anthony's bowels are going to take a little longer. My question is it has been 10 days after surgery. Do you think this is abnormal too long? The only thing that has been done to get his bowels moving is that they are giving him reglan and me attempting his bowel care with magic bullet and digital stim. Enemas do not and never have worked with Anthony. The surgeon said if the BP does not work tonight that he will give him some Miralax or magnesium citrate and another graphic study with barium from the NG tube. Why they didn't recommend this days ago I don't know. . . . .

    #2 He is on two types of antibiotics for after surgery, for pneumonia because of aspiraton when vomitting from blockage and another one for UTI that I think was misdiagnosed because they are going off of when he was taken to the ER they took the urine out of his leg bag! that is not how you get a clean sample but they are treating it anyway . . . .I believe both the pneumonia and UTI should be cleared by now being on antibiotics for 10 days now? He is also on IV TPN for nutrition.

    #3 there has been talk of moving him to a "long term acute care hospital" I have never heard of these. Anyway I think that is too soon and they do not allow caregivers to stay overnight so that is out anyway. But was wondering if anyone had any experience with these "hospitals"?
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

    #2
    It takes time. They wait a certain amount of time and then they do testing. 10 days is quite a long time. I hope he doesn’t have another obstruction. CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      What kind of testing? Yes I think we should ask for another catscan or barium study?, all they are doing are xrays. They say xrays look good but see stool in lower intestine so I don't understand why that would be blocking bile, etc. from going down. He is still getting quite a lot of bile coming out of the NG tube . . . . .
      Cindy Waters
      mom to Anthony, right c5, left c4 (24yo)
      injury march 2003

      Comment


        #4
        Ten days is definitely too long for post-operative ileus to resolve!
        Five or six days is the accepted limit for the bowel to shut down after surgery.
        Second opinion time.
        Personal experience: when i had my colostomy, they wouldn't give me anything orally-food or water-until I passed something through the ostomy. My stomach became a toxic experiment so I got an NG tube. On the 5th day I asked the two year resident surgical "team" if it wasn't possible they had transposed the bowel elements, that that would explain my symptoms, and they chuckled and said it wasn't possible.
        My abdomen became more and more distended.....so much so that I could barely breathe.
        We got another GI doc for a second opinion.
        He ordered tests on the eve of the 11th day.
        They did the test on the 12th
        Shortly, they wheeled me in for emergency surgery; they had connected my ass to my ostomy and stapled my large intestine in my gut!!
        I have to wet me to wonder what might of happened if we hadn't gotten another doctor involved; it is sobering.
        I am the poster child for medical malpractice, it's how I got paralyzed. It has taught me to be rigorous about who's on my team AND to expect adult, problem solving conversations with them.
        The surgeon that did my colostomy was NOT who I had hired because the mis-adventure 4 days in ICU made that not possible so I got who I got.

        Remarkable?
        Not really! I befriended a male nurse who also is an aquariast when I went to the ICU just before the surgery because of a huge reaction to some antibiotics.
        Five weeks later I revisited the ICU with sepsis post flap surgery and he greeted me: "You won't believe it! We had another backwards colostomy!"
        "How long did it take to diagnose it?" I asked.
        Twenty four hours.
        Progress, not perfection
        69yo male T12 complete since 1995
        NW NJ

        Comment


          #5
          Originally posted by pfcs49 View Post
          Ten days is definitely too long for post-operative ileus to resolve!
          Five or six days is the accepted limit for the bowel to shut down after surgery.
          Second opinion time.
          Personal experience: when i had my colostomy, they wouldn't give me anything orally-food or water-until I passed something through the ostomy. My stomach became a toxic experiment so I got an NG tube. On the 5th day I asked the two year resident surgical "team" if it wasn't possible they had transposed the bowel elements, that that would explain my symptoms, and they chuckled and said it wasn't possible.
          My abdomen became more and more distended.....so much so that I could barely breathe.
          We got another GI doc for a second opinion.
          He ordered tests on the eve of the 11th day.
          They did the test on the 12th
          Shortly, they wheeled me in for emergency surgery; they had connected my ass to my ostomy and stapled my large intestine in my gut!!
          I have to wet me to wonder what might of happened if we hadn't gotten another doctor involved; it is sobering.
          I am the poster child for medical malpractice, it's how I got paralyzed. It has taught me to be rigorous about who's on my team AND to expect adult, problem solving conversations with them.
          The surgeon that did my colostomy was NOT who I had hired because the mis-adventure 4 days in ICU made that not possible so I got who I got.

          Remarkable?
          Not really! I befriended a male nurse who also is an aquariast when I went to the ICU just before the surgery because of a huge reaction to some antibiotics.
          Five weeks later I revisited the ICU with sepsis post flap surgery and he greeted me: "You won't believe it! We had another backwards colostomy!"
          "How long did it take to diagnose it?" I asked.
          Twenty four hours.
          Progress, not perfection
          OMG What scary stories! when I came in this eve the nurse said they gave him 1/2 bottle of magnesium citrate, nothing came out the bottom even after dig stim and he filled almost 3 cannisters with bile out of NG tube after as well. He has been ordered a catscan with contrast stat as we speak and I have also asked how to get a 2nd opinion. But in this hospital I don't know if they have more than 1 GI group. What does "transposed the bowel elements" mean? I'm pretty sure at this point it is more than bowels are not waking up.
          I hate when Drs always try to blame paralysis for problems that occur they have been focusing on because he is paralyzed his bowels take longer to waken and I get it but not this long.
          Cindy Waters
          mom to Anthony, right c5, left c4 (24yo)
          injury march 2003

          Comment


            #6
            "transposed"=switched which is indeed what was done!
            69yo male T12 complete since 1995
            NW NJ

            Comment


              #7
              oh ok. Again scary . . .Finally this morning the surgeon came in and said he is going to do another barium graphic study and said stool has moved from right side to left side of lower bowel whatever that is supposed to mean. Sill a lot of bile coming out of NG tube. I don't understand what the difference is if there is stool in his large intestine what that has to do with the large amounts of bile coming out of NG tube. He also is having his partner also a surgeon come in to assess as well. The hospitalist that he has today was of no help when we inquired about getting a 2nd opinion. Said we didn't have much to choose from instead of giving us names of GI Drs. that have privileges at the hospital. I did some research and only found one group and the nurse called him back and said Anthony wanted them to be consulted so that is happening now.

              Usually when you have surgery I thought the surgeon has done his job then that specialty of Dr. was consulted no GI dr. was every consulted. Nothing seems organized!
              Cindy Waters
              mom to Anthony, right c5, left c4 (24yo)
              injury march 2003

              Comment


                #8
                The bile is supposed to be absorbed with the stool for the bm then out it should go. Seems there is something blocking or backing up and the bile is produced but no where to go. Was that CT without contrast?Contrast CT would have shown them. But contrast thru NG tube will show the patgway . CWO
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                  #9
                  I was able to get a better explanation from a different surgeon and a GI doctor that I had to find was consulted so explanation in depth is more than just he's paralyzed his bowels are waking slower than usual. In-depth explanation was his upper lower intestine could have been distended for some time since he can't feel pain so his stomach was stretched for maybe a day or two I was not home before he started vomiting and showing signs of obstruction so that's one trauma; second trauma was the surgery itself and there is still swelling from that, the third is the paralysis and the slower movement of wave action coming back they are doing a gastrographic study tomorrow which is where they give him barium down his NG tube and take a series of x-rays throughout the day to see where the barium goes to see if there's another actual mechanical obstruction or partial blockage by swelling or something else. The gi Dr also ordered fluids that no other Dr had done and after the study tomorrow he will order erythromycin which is actually a kind of laxative antibiotic depending on what they find, so feeling better now that two drs have actually explained it to us in detail
                  Cindy Waters
                  mom to Anthony, right c5, left c4 (24yo)
                  injury march 2003

                  Comment


                    #10
                    So the gastro graphic study was done today, barium up the NG tube with series of xrays original surgeon called and said they could see the dye go all the way down within a half an hour then hit some stool in the lower intestine and explained that is why the bile is still coming up . . .oops just got a phone call he is surely unblocked cleaning up now
                    Cindy Waters
                    mom to Anthony, right c5, left c4 (24yo)
                    injury march 2003

                    Comment


                      #11
                      Hopefully he’ll have some relief
                      C4/5 incomplete, 17 years since injury

                      "The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same.” - Carlos Castaneda

                      "We live not alone but chained to a creature of a different kingdom: our body." - Marcel Proust

                      Comment


                        #12
                        Just wonder on the barium swallow how they can tell it is only stool and not something else with it.
                        CWO
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment

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