Q. My father has poor wound healing after GI surgery. Please suggest.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jan 17, 2021

Hi doctor,

My father is 84 years old and he has a history of GI blockage at the cecum due to surgery. He has delayed scarring due to recurrent blockage. Five feet of the small intestine was removed and reconnected with a stent. The major complication observed is delayed healing. His feces is leaking and muscle closure is poor. A vacuum is placed to suck the feces and he has intense pain. The doctor told that there is no other way to do for this problem at this stage other than the same treatment to suck the poop with drain and pain medicines to control pain. Is there an alternative preoperative and postoperative measure that can help to cure wounds after ostomy surgery where the diseased small intestine is cut? Poor healing is always a risk and stoma placed in an external site will have easier access than dealing with the internal problems and so the feces is leaking internally. The distal end is closed and I am not sure about distal leakage. This surgery was performed before six months through direct access. But GI tubing was only massaged and it was never cut and the blockage was cleared. The external wound took a long time to get healed and the primary closure failed. Please suggest.

#

Hi,

Welcome to icliniq.com.

I can understand the situation. Your father is going through a tough time in his life. It is always challenging to operate on this patient with such an age and it is always concerned about healing of the postoperative wound. I can figure out the information shared by you. There is an open wound with vacuum suctioning and there is another catheter placed in the stomach for feeding purposes. Please mention the aspirate in the vacuum tube whether it is present with blood, water or feces comes directly into the skin, and what is the color of it. Its quantity is important to know whether it is a fistula or due to primary failure of healing between the proximal and distal loop. I want to know whether he is able to pass stools from the anus.

The picture suggests that he has a controlled enterocutaneous fistula (attachment removed to protect patient identity). It means that the bowel beneath is directly connecting the skin. So most of the contents of the bowel are discharging to the surface. These large enterocutaneous fistula show healing. But it is not guaranteed and there is a risk of rupture again. It is not good to do a further surgical intervention in this stage and it is good to continue suctioning and giving analgesics to have healing naturally. But it takes time. If you are going to re-operate or putting a mesh over there, there are higher chances to have migration of mesh or dislodging and the wound can rupture again.

The best way is to give him good nutrition or a high protein diet and give him time to have spontaneous closure of the fistula naturally. Please mention whether he manages his diet intake orally or through an intravenous tube. Because we can work on it to speed the healing process by giving good calories in a day. As he had 5 feet resection of the small bowel, he is unable to absorb calories from the rest of the gut. It is best to consider tube feeding with control monitoring or consider total parenteral nutrition (TPN) or intravenous nutrition.


The Probable causes:

Your father has enterocutaneous fistula with a wound by secondary intention and there is poor wound healing.


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