Hi, am hoping someone is out there who has had experience with a mucous fistula in between step 1 and 2 of a three step. Husband had horrible colon removed and the end was so bad that they couldn't leave it in so they brought it out through the bottom of his incision and now its a mucous fistula. The end of it looks like hamburger, literally. It seeps blood normally so he has to wear a "Little Ones" pediatric bag on it. I am told this is normal. It normally has been draining pink drainage about 75cc twice a day. The only time it drained frank blood was when he was on coumadin for blood clots and he almost bled out. Got two units of blood that brought him up to a hemo of 10 or so. Stopped coumadin a couple weeks ago and drainage went back to pink. Once in a great while some will want to come out the "back door" but not very often. He was getting his color back and felt normal again.

Well this morning he gets up and the MF bag has its 75ccs of FRANK blood in it and a huge clot hanging in there. He feels crummy and his heartrate is around 110 up from 95 or so normally but BP is still normal. I feel like an idiot because I am a nurse and so I naturally find this alarming but in the past when I have called the CCF surgeons office about this MF drainage, they keep telling me its normal and don't worry. I haven't called today because its sunday and they will just tell me to go to the ER, if I could even get a real person on the phone. Our local ER has seen him in the past for dehydration/blood loss and they don't want to do anything because its a CCF case.

I guess my question is: has anyone had any experience with totally inflamed mucous fistulas and should I be running him down to the CCF ER? I am watching his vital signs but this just doesn't feel like it is normal to me to have 75ccs of frank blood in your bag plus now its coming out the "backdoor" too. I can't tell how much blood is going into the toilet bowl either. How long should I allow this to go on? I really hate how I have no access to medical help on the weekends. Help!

I think at least a call to the CCF ER is not out of the question. If I was close by, I would live there on the weekends! I feel the desperation of weekend problems. At least the two of you can work through this. Gee, I hope things get better. A nurse is a good thing, I feel often better than a doctor. But certainly not an idiot. I have the claim to being the village idiot! Good Luck Arthur

Sorry I didn't see this yesterday, but I hope that things either stabilized or you got him to the ER. Obviously, you know that with the worsening tachycardia, this is a sign of increasing anemia and/or hypovolemia and he would need at the very least, fluid replacement and hemoglobin/hematocrit determination of anemia. His tachycardia was not too bad at the time of your post, but you know to keep an eye on it.

As far as the bleeding mucous fistula goes, I would think that it is OK as long as it is blood tinged drainage, but when you are passing large clots, that means a brisk bleed. Has he been getting any topical treatment of the rectal remnant while awaiting his next surgery (such as hydrocortisone or Rowasa enemas)? If not, it is probably time to look into this.

Jan