Rectal catheter the norm following surgery?

A close friend recently underwent a full colectomy and ileorectostomy (he had his colon removed and his small intestine reconnected to his rectum). He had some major problems following the procedure, but thankfully he survived. It's my understanding that the problems he had were very unusual and occur infrequently.

I'm trying to piece together some information about what might have led to his post-surgical problems. I'm wondering whether it's the norm to have a rectal catheter in place for a few days following a colectomy with ileorectostomy? Thanks in advance for any experience you can share.

Yes, I believe Ileorectal anastomosis is the same as colectomy + ileorectostomy.

I beleive my friend will fully recover, but we're trying to understand what happened (which I haven't described purposefully as I don't want to influence responses).

Thanks!

Thanks, Pibbin, for sharing your experience and expections for your upcoming surgeries.

Did they give you any information that you could pass onto me that would help me understand why it wouldn't be necessary after reconnection (your third surgery)?

Yes my friend had it all done in one step. He doesn't have a J-pouch or anything... his colon was removed and his ileum was reconnected to his rectum. Therefore I believe his post-surgical experience would differ greatly from Pibbin and tbraz. You both had rectal drains but would have had non-fecal discharge whereas my friend had fecal discharge immediately following his surgery. (Thank you both so much for sharing your experiences with me. I hope you are well and future procedures go well.)

I'm looking for information regarding whether a rectal catheter is recommended for fecal discharge immediately following ileorectal anastamosis.

I had one too.
They kept it in the whole time I was in the hospital and removed it the day I was released.
Didn't bother me at all.

I had a different surgery than your friend sorry.

Thanks much to all who replied. The doctors aren't being straight with my friend, but we (his family and friends) have pieced together some things based on doctor statements and their reactions to each other. We believe my friend was supposed to have had a rectal catheter in place for several days following the sugery, but did not. It hadn't been discussed with him at his pre-op meeting so he didn't expect or miss it. When the medical team came to take it out they found he didn't have one. (He had to tell them three times he didn't have one before they believed he really didn't.) We all recognized that, uh, yeah, that would have been a good thing to have had in place. Instead, he had constant watery-diareah-like movements and was trying to make it to the bathroom from within hours after surgery. He often didn't make it, but he tried. (And none of the medical team acted like this was out of the ordinary, so we all accepted it as the norm.)

He ended up with a "leak" at the site where his ileum was reconnected to his rectum. He had fecal matter, etc. leaking into his abdomon for several days before they did a CT scan to see what was going on. He did eventually recover from the massive infection but he had a lot of complications and has some continuing concerns.

We now are now wondering if the leak occurred because he didn't have a catheter and because he was holding back movements that were coming with violent force. I've been researching this and have learned that "leaks" like this are pretty rare, but I can't find any info on the standard course of post-op care, i.e., whether a catheter is routine.

It may be that the only thing the catheter would have prevented would have been a great deal of suffering and humiliation (i.e., perhaps its omission didn't cause the leak) but we're pretty sure he would have died without us being there to force them to act when it was apparent he was dying and they were playing hot potato. Regardless, my advice to anybody who is going to be hospitalized at any time for anything (based on several experiences, not just this one) is to research it extensively beforehand so you know what to expect, and to bring bodyguards (friends and family) who have been educated. 

Specifically, be sure you understand the worse case scenarios, how to recognize them, and who will be responsible for seeing you through any problems that occur. (That last part may be more important than you might assume.) See this past Sunday's Parade Magazine (insert to many Sunday papers) for the type of things to watch out for.

AtHome--did your friend have an abdominal drain?  My cr surgeon always put one in no matter what surgery I had.  It did alert us, once, to an abdominal leak when I started eating after a resection.  Its job is to keep any fluid, that shouldn't be in your abdomen, from becoming an issue.

You friend is very lucky to have people who CARE about him!!

 

Hello AimingforSerenity,

I am so sorry to hear about your friends complication. However, I had the same operation (Ileorectal anastomosis) in April of this year. Two key differences between your friend and me would be A. I did not have a one step - I was given, and still have, a temporary loop ileostomy. B. They did not use a rectal catheter.

I also had a leak at the anastomosis site (where they connected the ileum to the rectum). I was hospitalized for 6 weeks, with recurring abdominal abscesses (9 total) and a host of other issues. However, my situation, although bleak and horrible, was not as severe as your friends as it sounds like sepsis occurred due to the one step surgery allowing waste to enter the blood stream. My problem was not waste, of course, but there are still bacteria in the intestine that leaked from the anastamosis site and created the abdominal abscesses.

The only other thing I know for certain (because my surgeon warned me pre-op and I researched the heck out of it) is that the chances of having an Anastomotic leak following ileorectal anastomosis are much, much higher. My surgeon did not give me an option for a one step surgery due to the severe risk of leaks and would only do the two step with the temp ileostomy - and I am darn glad he did!

This link discusses the findings of leaks in Anastomosis by type. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876987/ . If you scroll down you will see result and a table that shows the leak percentages for all types of anastomosis. Shocking to discover that the mean average of leaks is only 2.7%. However, for Ileorectal Anastomosis the leak percentage is an astounding 23.3%!!!

My leak began to heal and I have had no abscesses for a month. I go in for a Barium Enema (they are so much fun) on Thursday to make sure but they think it has healed.

Not sure if all of that helps but I certainly hope that it does.