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What Causes High Fever, Diarrhea And Weight Loss After Colorectal Surgery?
Question: This is about my grandfather who lives in Beijing China. I have not talked directly with the physicians/surgeons but have only been relayed information as I now live abroad.
Background:
My 76 year old grandfather discovered he had very early-stage colon (large intestine near rectum) cancer 2 months ago. A month and a half ago, he went through colorectal surgery (partial colectomy) to get the tissue removed. The surgeon told us that everything seemed fine and there were no complications. However, my grandfather began to develop a high fever (38-39 Celsius), diarrhea, weight loss, and other irregular post-surgery problems. I believe imaging also showed large fluid build up in the pelvic cavity.
I suspected that there was a problem with the suturing of the wound and I told the surgeon this. Seeing he was prideful of his work, he told us that there does not seem to be a problem. However, we had another specialist check later and it was discovered that the stitched was not done properly and there seemed to be an opening along with severe inflammation. They did a second procedure where they inserted a tube to bypass the wound. Now, feces will travel through the tube and into a bag outside the body to let the wound heal.
Two days after discharge, my grandfather noticed an infected open wound near his rectum. It started to get deeper and deeper followed with inflammation, puss, and some blood. At first, the hospital give him some antibiotics and some ointment (I am not sure what it was). However, the open wound got worse and the ointment did not seem to stick well to the wound. After a week, he was readmitted into the hospital and was put on antibiotic treatment. Although I have not confirmed, my grandfather has told me the wound may have created a tunnel to the pelvic cavity as there is constant leaking of fluid from the wound. The nurses have to change the bandages very often due to this fluid.
Recently, the doctors stopped the antibiotic treatment and is using "Traditional" medicine by applying a new cream/liquid directly on the wound. After stopping antibiotic treatment, the wound has gotten much worse. I have not confirmed reason for stopping antibiotic treatment.
Personal opinion:
I have a strong feeling this wound is a Hospital Acquired Infection (HAI). Considering China's overuse of antibiotics and sometimes slightly nonstandard sanitation protocols, HAIs seem to be quite common in China and difficult to treat due to presence of antibiotic resistance. I was also told the doctors at the hospital are overworked and are currently not very attentive of my grandfather's condition. As I am an infection disease/immunology researcher, I feel that antibiotics should not be started/stopped repeatedly as it is likely to cause more resistance. However, I am not a clinician so I do not know the practical aspects.
Questions:
1. Should the doctor have stopped antibiotic treatment?
2. What antibiotics or treatment plans would you recommend?
- Are there any antibiotics that China uses less? Less likely to have resistant.
- Is there an antibiotic spray or cream that would be more effective than oral/intravenous antibiotics?
3. Is there any other treatment methods or suggestions you have for my grandfather's condition?
Thank you very much for you time and suggestion.
Background:
My 76 year old grandfather discovered he had very early-stage colon (large intestine near rectum) cancer 2 months ago. A month and a half ago, he went through colorectal surgery (partial colectomy) to get the tissue removed. The surgeon told us that everything seemed fine and there were no complications. However, my grandfather began to develop a high fever (38-39 Celsius), diarrhea, weight loss, and other irregular post-surgery problems. I believe imaging also showed large fluid build up in the pelvic cavity.
I suspected that there was a problem with the suturing of the wound and I told the surgeon this. Seeing he was prideful of his work, he told us that there does not seem to be a problem. However, we had another specialist check later and it was discovered that the stitched was not done properly and there seemed to be an opening along with severe inflammation. They did a second procedure where they inserted a tube to bypass the wound. Now, feces will travel through the tube and into a bag outside the body to let the wound heal.
Two days after discharge, my grandfather noticed an infected open wound near his rectum. It started to get deeper and deeper followed with inflammation, puss, and some blood. At first, the hospital give him some antibiotics and some ointment (I am not sure what it was). However, the open wound got worse and the ointment did not seem to stick well to the wound. After a week, he was readmitted into the hospital and was put on antibiotic treatment. Although I have not confirmed, my grandfather has told me the wound may have created a tunnel to the pelvic cavity as there is constant leaking of fluid from the wound. The nurses have to change the bandages very often due to this fluid.
Recently, the doctors stopped the antibiotic treatment and is using "Traditional" medicine by applying a new cream/liquid directly on the wound. After stopping antibiotic treatment, the wound has gotten much worse. I have not confirmed reason for stopping antibiotic treatment.
Personal opinion:
I have a strong feeling this wound is a Hospital Acquired Infection (HAI). Considering China's overuse of antibiotics and sometimes slightly nonstandard sanitation protocols, HAIs seem to be quite common in China and difficult to treat due to presence of antibiotic resistance. I was also told the doctors at the hospital are overworked and are currently not very attentive of my grandfather's condition. As I am an infection disease/immunology researcher, I feel that antibiotics should not be started/stopped repeatedly as it is likely to cause more resistance. However, I am not a clinician so I do not know the practical aspects.
Questions:
1. Should the doctor have stopped antibiotic treatment?
2. What antibiotics or treatment plans would you recommend?
- Are there any antibiotics that China uses less? Less likely to have resistant.
- Is there an antibiotic spray or cream that would be more effective than oral/intravenous antibiotics?
3. Is there any other treatment methods or suggestions you have for my grandfather's condition?
Thank you very much for you time and suggestion.
Brief Answer:
Post Colectomy Peri-anal Fistula with Anastomotic Leak with Pelvic abscess
Detailed Answer:
Brief Ans-Post Colectomy Peri-anal Fistula with Anastomotic Leak with Pelvic abscess
Hi Dear,thanks for your detailed query regarding health concerns of your grandfather who is being treated in China,Beijing.
My Perception - on Your grandfathers current Condition-
Based on the facts of your query,your grandfather is facing following 2 Major-health issues-
1-1 mth back-Partial Colectomy with ? Anterior Resection for a Cancer of Large intestine near Rectum+
b-With post-operative Pyrexia with pelvic Sepsis /abscess from Anastmotic leak
c-Treated by lavage of the pelvic cavity fluid+Antibiotics +tube feacal drainage to bypass the anastomotic wound to allow it to heal.
2- Non-healing Peri-anal Fistual?(mostly high pelvic type) after Second Surgery with tube feacal drainage,
In such a complicated scenario,lot would be required to be done and is out of perview of one interaction like this with you.
Looking to the age of your grandfather(75 yrs),a complicated surgery with all the complications in post-operative period as in your case is not uncommon event in few cases of advanced age.
Still with limited facts on actual condition and facts from a attending doctor,
all these second opinion comments have limitations of being more of a academic and hypothetical suggestions for your ailing grandfather in China.Its application ultimately needs to be done with discussions with the local attending doctor.
With this reality I would do My best to reply your queries as follows-
Questions:
1. Should the doctor have stopped antibiotic treatment?-
AS the antibiotics were not useful in controlling the surgical complication with infection,which needs correction of the pelvic pyogenic fluid,They had to stop it,else his general condition would deteriorate.
2. What antibiotics or treatment plans would you recommend?
Ans-AS replied above -Your grand father would require-
a-Correction of the Pelvic Infection with recurring abscess due to the failed anastomosis
b-Excision of the Pelvic Abscess with its wall along with Anastomotic mass with closure of the Rectal end
c-Along with Excision of High Peri-anal Fistula
d-And -Colostomy to drain the feacal matter
Only antibiotics would not help your grandfather and the basic cause for the infection needs to be treated in your grand father's case.
- Are there any antibiotics that China uses less? Less likely to have resistant.
Ans-Local doctors would be in better position to ask this question.
- Is there an antibiotic spray or cream that would be more effective than oral/intravenous antibiotics?
Ans-Surgical Correction as suggested above in stages is the only solution,as no antibiotics could cure-if the peri-anastomotic infected focus is not removed.
3. Is there any other treatment methods or suggestions you have for my grandfather's condition?
Ans-Corrective Surgical Care of the Peri-anal fistula with excision of the pelvic abscess with closure of the leaking anastomotic site with Colostomy to drain the faeces, is the only answer in your grand fathers case.
Hope this reply would enlighten to the way out of the treatment in your grand father's complicated case,and would help you to plan and help the doctors there to give the best care to your grandfather.
Welcome for any further query in this regard.
Hope this reply would satisfy you.
Good Day!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Post Colectomy Peri-anal Fistula with Anastomotic Leak with Pelvic abscess
Detailed Answer:
Brief Ans-Post Colectomy Peri-anal Fistula with Anastomotic Leak with Pelvic abscess
Hi Dear,thanks for your detailed query regarding health concerns of your grandfather who is being treated in China,Beijing.
My Perception - on Your grandfathers current Condition-
Based on the facts of your query,your grandfather is facing following 2 Major-health issues-
1-1 mth back-Partial Colectomy with ? Anterior Resection for a Cancer of Large intestine near Rectum+
b-With post-operative Pyrexia with pelvic Sepsis /abscess from Anastmotic leak
c-Treated by lavage of the pelvic cavity fluid+Antibiotics +tube feacal drainage to bypass the anastomotic wound to allow it to heal.
2- Non-healing Peri-anal Fistual?(mostly high pelvic type) after Second Surgery with tube feacal drainage,
In such a complicated scenario,lot would be required to be done and is out of perview of one interaction like this with you.
Looking to the age of your grandfather(75 yrs),a complicated surgery with all the complications in post-operative period as in your case is not uncommon event in few cases of advanced age.
Still with limited facts on actual condition and facts from a attending doctor,
all these second opinion comments have limitations of being more of a academic and hypothetical suggestions for your ailing grandfather in China.Its application ultimately needs to be done with discussions with the local attending doctor.
With this reality I would do My best to reply your queries as follows-
Questions:
1. Should the doctor have stopped antibiotic treatment?-
AS the antibiotics were not useful in controlling the surgical complication with infection,which needs correction of the pelvic pyogenic fluid,They had to stop it,else his general condition would deteriorate.
2. What antibiotics or treatment plans would you recommend?
Ans-AS replied above -Your grand father would require-
a-Correction of the Pelvic Infection with recurring abscess due to the failed anastomosis
b-Excision of the Pelvic Abscess with its wall along with Anastomotic mass with closure of the Rectal end
c-Along with Excision of High Peri-anal Fistula
d-And -Colostomy to drain the feacal matter
Only antibiotics would not help your grandfather and the basic cause for the infection needs to be treated in your grand father's case.
- Are there any antibiotics that China uses less? Less likely to have resistant.
Ans-Local doctors would be in better position to ask this question.
- Is there an antibiotic spray or cream that would be more effective than oral/intravenous antibiotics?
Ans-Surgical Correction as suggested above in stages is the only solution,as no antibiotics could cure-if the peri-anastomotic infected focus is not removed.
3. Is there any other treatment methods or suggestions you have for my grandfather's condition?
Ans-Corrective Surgical Care of the Peri-anal fistula with excision of the pelvic abscess with closure of the leaking anastomotic site with Colostomy to drain the faeces, is the only answer in your grand fathers case.
Hope this reply would enlighten to the way out of the treatment in your grand father's complicated case,and would help you to plan and help the doctors there to give the best care to your grandfather.
Welcome for any further query in this regard.
Hope this reply would satisfy you.
Good Day!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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