Help with Post-Ileostomy Complications

Hello, and I am really sorry I had to write it as a non-patient. My sister-in-law had ileostomy surgery last Monday. All went well there, but this Sunday, she started feeling ill, vomiting with no stool passage. My wife, who is a veterinarian, knew that Ondansetron could help and administered it via IV. She felt a bit better, then started to feel a bit sick, at which point she went to the ER to see her doctor who really knows her condition. It should be mentioned that she also has desmoid tumors that can cause adhesions, but my sister-in-law, knowing her own condition for 10 years, felt like there had to be a medical way to let the blockage go on its own. Last night, she had stool in the stoma and small bowel movement. She hasn't vomited for a few hours. Today, she realized the nurses administered Ketonal and Drotaverine every 8 hours. She knows that these can cause constipation. She specifically asked to be taken off them and only be administered Ondansetron. The doctor was okay with it, and she doesn't seem anxious about anything too much. Last night when she had stool, her abdomen was soft; today it's a bit hard again. What is your medical advice on the next step she could take?

I only want to help her as much as I can, by at least keeping myself informed. I love my wife, and I know that she values her sister a lot, so I can't stay passive to this. Thank you so much for all the answers.

Hi there, if she is not having movement and has not had output from her ileostomy and is sick to her stomach, she needs to go to the ER and contact her doctor. It's not something to wait on. They need to find out why she is not having movement and it could be numerous things.

Hi GH, I've had an ileo for 30 some years, and when that would happen to me, I went to the ER and would be given muscle relaxants and IV fluids. Finally, after being scoped over the years, my doc said it was time to have resection surgery to get rid of scar tissue caused by Crohn's and adhesions from previous surgery. I haven't had any issues since.

I am not qualified to give 😷 advice as you asked for. I will suggest that she seek medical advice from her doctor. It sounds like a blockage to me. Whether from adhesions or not, she needs to go.

Hi Georgian,

I'm not familiar with the medical system in Romania at all, but speaking specifically about your sister-in-law's ileostomy... she's got a lot going on. Odansetron, known as Zofran here in the States, is given to suppress nausea... but it also slows bowel motility. Ileostomates don't have their colon in play, so they don't normally get constipated, per se. But having desmoid tumors sure adds to the mix, but I'm assuming those are being watched medically and haven't been allowed to grow to the point they're restricting bowel flow. If they have, your sister-in-law is in a world of hurt, and all bets are off. Ketonal is an NSAID like Ibuprofen, but can also cause constipation, as well as nausea and an upset stomach. Drotaverine is an antispasmodic drug given to help reduce muscle spasms in the gastrointestinal tract... but like the others, it can also have a side effect of constipation.

So your sister-in-law has a lot going on. No one on here can give her good, sound medical advice for a whole host of reasons. And without knowing the whole story... and with none of us being doctors... don't pass on any advice from this site to your sister-in-law. The best care she can get will come from those who are looking at all her data and considering all that is going on. I know you want to help her, but asking around on forums for sound medical advice is NOT going to help her. I'd suggest you get as many medical opinions from professionals in your area as you can. Please let us know how she makes out and if there's anything else we can do.

Regards,

Bob

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Oh, no, totally. I would never make the irrational choice to give unprofessional medical advice to anyone. My sister-in-law will go into surgery tomorrow morning so that her surgeon can look at her bowel and see if it's a blockage or adhesion keeping her in this state. I've done TONS of research, but then I realized that here are the only people that can help me at least understand these issues from the point of view of someone actually going through this type of distress, in order to give me and my wife peace of mind. Of course, I will never intervene with an opinion based on anything on the internet. I'm just the type of person who needs to understand the depths of an illness of someone close to home in order to give my best support, to its finite extent, of course. Your answer was really genuine and helpful, and I commend you for your patience to write all of these down for me in such an eloquent manner. Thank you. Hope the surgery she'll undergo tomorrow will go well and without any complications.

Hi G,

Gotcha! Ok, you asked... so in terms of what she's feeling, I think we can help you out. The small bowel has the ability to expand quite a bit without sending pain signals and us feeling anything is really wrong. But it has limits. The bowels are full of nerves, but they only send out pain signals to the brain when the bowel is stretched beyond that certain point. When that point is reached, it's VERY painful. When someone obstructs, the pain can become so great that your body's response is to put you in shock and have you pass out. This is to prevent the brain from being overloaded by pain signals, which generate electricity of sorts that the brain interprets. I've been told the pain of obstruction is worse than a woman being in labor, which it must be to have your brain shut you down. I've been through the former many times but the latter never, so I can't say how true that is. But I've had docs tell me they were amazed at the level of pain I've endured. The other thing about obstruction pain is that it comes in waves, as the bowel does its locomotion thing trying to move stuff along. So when obstructed, you'll be at a pretty high pain level and then feel it start to slowly increase. And when you think it can't get any worse... it does. And then it subsides a bit before it comes back a little stronger, and this process just continues until your brain says 'enough' and you pass out. Left unchecked, your bowel will eventually burst, allowing all its contents to enter your abdominal cavity, causing sepsis and then death. So when the bowel ruptures and you spring a leak, it's no joke, and at that point, you literally have only hours to live, if that. But you usually get a lot of warning signs to get help before it gets that bad. When I was going through full obstructions, I had to lock up my guns and give my friend the key, as I would have blown my head off to stop it if I could. It gets that bad. You no longer think straight, and the only thought that occupies your mind is to make it stop... any way you can. But hopefully, your sis-in-law will never experience anything like that, and they'll figure out what's wrong tomorrow. Like I said earlier... keep us in the loop, and we'll explain what we can to you so you better know what she's dealing with. You take care.

;O)

Bob

I want people to understand, because maybe I was vague about it, she already is in the hospital. She didn't respond to the first line of medication, so today is the big operation day. I just wanted to understand her story better and you, Bob, gave me the raw image and even if it's horrible, I needed to know and be aware of all of these. I am a very empathetic person and the pain of someone close can never be left unacknowledged and unlearned. Keep us in your best prayers, she will be okay, I hope and feel it.

How is she doing?