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PostOp complication of Cystectomy – URGENT
My father had hematuria issues from few months and eventually got diagnosed with High Grade Muscle Invasive Urinary Bladder Cancer on March 23, 2015 post a biopsy performed through cystoscopy. We went for a second opinion and were suggested that we should get another biopsy done in 4 to 6 weeks from the first biopsy date. We got the second biopsy done on April 20, 2015 and the results were on the same lines. The only feasible option suggested by all the relevant doctors was to get the radical cystectomy (RC) done with an ileal conduit as it was high grade muscle invasive with the tumor site being at the mouth of the bladder (nearing prostates) ruling out neobladder.
My father underwent the RC on April 29, 2015 and the surgery, being a major one, lasted for around 8 hours and he spent couple of days in ICU and post which he spent another 6 days in the hospital room recovering. He had high NG aspiration, close to 1500 to 2000 cc per day and had no motion all througout and was able to pass gas only on the seventh day. All this while, he was doing all the recommended exercises and was walking as per his ability. He was sent for CT scan and it showed internal hernia with intestine intruding into the muscle layer near the stoma.
Apparently, due to this post operative complication called Internal Hernia, he had to undergo another surgery for its correction on May 8, 2015. He was shifted to ICU post this surgery and on day 3 i.e., May 11 (still in ICU), post walking for the second time around afternoon, he had bouts of breathlessness and was put on oxygen mask. He also had high sodium levels, low potassium levels, high heart rate and was kept in close observation for next two days. Finally, on Day 4, he passed motion once. His heart rate started decreasing since day 5 and also the sodium and potassium levels improved. He again passed motion on day 6, 7, 8, and today and continuously passing gases since day 6 on a daily basis. However, all this while he is facing the issue of abdominal distention wherein his abdomen area looks swollen and extremely tight with pain on the left abdomen now and then.
Today, May 17, 2015 he is still in ICU and abdominal distention has started to decrease slightly and all the other vitals are continuously in control. In the last 4 days, he has been given the blood transfusion as well due to low HB levels which are now at 10.3. As of today, his BP, Heart rate, Respiratory/saturation levels and temperature are normal but the only problem is the abdominal distention which is not subsiding quickly. Today, they even started the liquid diet wherein he is given sips of coconut water since morning. Its been like 20 days since he has eaten food and been on IV and TPN all the while and also continuously been given the antibiotics, sodium correction, potassium correction and laxative suppositories for bowel movements.
I wanted to know from the forum that if anyone has ever come across this kind of situation and if yes, how many days does it take for the person to come out of it and what is the best possible solution for this problem. My whole family and I are really worried for my father and feeling helpless at this moment. Any insights would be greatly appreciated. Thanks in anticipation!
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2 Replies
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Hello Sara,
Thank you so much for the prompt reply. It is very helpful to know many patients have had similar post-op problems but have done just fine after taking a long time to recover.
I will start with the good news that my father’s abdominal distention has started reducing since yesterday. They closed the NG tube yesterday and the liquid diet is continued. He is feeling much better as the tightness of the abdomen has reduced after passing motions thrice (he was given Enema). The surgeon has said that if all looks fine for next 24 hours, he will be shifted out of ICU tomorrow. Fingers crossed.
We spoke to surgeon and it seems there are two options in these kind of post-op complications, first one being the conservative option (preferred) of waiting for the intestines to resume work while maintaining the body’s vitals using IV fluids, antibiotics, TPN, etc. Second option is to do the exploratory laparotomy again wherein they will go in and check for any mechanical obstructions.
We are hopeful that my father will recover soon. Thank you for your best wishes!
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So sorry to hear about your father’s post-surgery problems. As you know, this is a very serious surgery. We are not doctors, so cannot offer any medical advice or real diagnostic information. I do know that many patients have had post-op
problems,. taken a long time to recover, and done just fine.You and your family need to have a long, serious talk with the surgeon to answer your questions. Insist on this,
Will be thinking really good thoughts….
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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