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Had a strangulated hernia a year after having a stoma. Have fistula that is bleeding. Any advice?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
I had a strangulated hernia ayear after having a stoma, had to have an emergency operation now I have a fistula that is bleeding all the time. I have to have another operation. There is an odour at times my consultant thinks there could be a stitch or the mesh that was used in the operation. Had to mve the stoma from my right side to my left
Posted Mon, 13 Aug 2012 in Abdominal Pain
Answered by Dr. Ketan Vagholkar 6 hours later
Thanks for writing in.
Since it was a strangulated hernia , the gangrenous part on the bowel must have been removed with joining of the otherwise normal ends. Thereafter you seem to have developed infection and a fistula from the operated hernia site.
Now if the fistulous fluid contains intestinal contents then it is a cause for concern.
You now need to undergo acontrast enhanced Ct scan of the abdomen. that will be reveal the true stateof affairs in the abdomen. It will provide the surgeon with yard stick for further surgical intervention.
The surgical treatment now would involve a formal abdominal operation.
The loop of intestine responsible for the hernial site fistula needs to be excised.The cut ends reanastomosed.The previous stoma needs to be refashioned both site wise and functionally. The normal healthy bowel proximal to this fresh anastomoses needs to be brought out as a stoma on the opposite side .If a mesh was used then that has to be removed at any cost to enable healing at that site. This will allow healing to take place at the previous site.
An important deterrant is if you are on steroids. You have stop them immediately as that can lead to a failure of the operation.
Another thing is meticulous wound management as the chances of wound dehiscence would be very high.
I hope this answers your querry.
With regards
Above answer was peer-reviewed by
Follow-up: Had a strangulated hernia a year after having a stoma. Have fistula that is bleeding. Any advice? 7 hours later
What is wound dehiscence They have the stoma and I think the wound is on the old site. As I have told you aleady the wound is bleeding and their is an odour this op was done in Oct 2011. They have not done any scans on my stomach at all.

Thank you
Answered by Dr. Ketan Vagholkar 2 hours later
Wound dehiscence means breakdown of the wound. That is the wound does not heal at all. As a result when sutures are removed the wound opens or gapes open.
Bleeding and odour from the wound is suggestive of infection.
You need to get admitted to hospital at the earliest.
Antibiotics and supportive care to control infection.
Scanning to evaluate the status of infected collections.
This should be followed by surgical intervention.
I hope this answers your querry.
with regards
Above answer was peer-reviewed by
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