AMB,

First of all I am sorry you are going through this. In the couple years after I got my pouch, I had around 4 blockages or obstructions. If that's what you are going through, I know it sucks, but even if it's not a blockage it doesn't make it suck any less.However no BMs in 3 days makes me think you do have a blockage/partial blockage. My experience with them was that they got worse over time and I experienced a knotted up sensation and then increasing pain. I needed a NG tube for one of them, but 3 others alleviated when I began vomiting. The violent wretches and spasms of my abdomen during vomiting seemed to have dislodged the plugged up food. One time I was all the way to the ER and they were just about to NG tube me when I started vomiting and the blockage freed and I moved my bowels.

As you may know, I am also strictured at the Pouch inlet, although I have a 30 year old pouch and that stricture built up over 29 years, probably from backsplash stool and pooling of stool above the inlet, which caused inflammation over time. My stricture closed up last year to the point where my doctor couldn't easily get a scope through summer of 2021. After that I had 3 dilations which created an 18 mm clearance in the inlet.

During the time I was strictured badly, I never had a blockage or obstruction. Therefore I am not suspecting the issue is your "slight stricture."

If you continue to have no BMs, or start having pain, get your ass to the ER and let them figure it out. Any sign of worsening, or pain, get to the ER ASAP.

STOP taking anything that slows down your bowels. No booze, marijuana, pain meds, or anything else that is remotely constipating. Also including the antibiotics. I have a friend who was popping oxycodone like candy after 3 level cervical disc fusion surgery and he ended up in the ER with "impacted stool", in others words severe constipation. They had to perform a fecal disimpaction on him.

Hey CTBarrister, thanks for your comments. In the ER they wanted to give fentanyl for pain! I refused on the grounds it would slow motility.  We settled on IV Tylenol.

I have been on Rifaximin with CIPRO down to 250 mg daily, easing off it when this occurred.  Tried Rifaximin when back from hospital  but vomited, and no meds since.  

So if stricture and obstruction not related, do you know what generally causes the obstruction / that's what I think it is - or is it something  else?  It it just the wrong combination of food?  I had a houseful and was eating less thoughtfully for the two days leading to this.  

Abdomen sore & somewhat distended &
 I've got loud gurgling now that I did not have at first. Is this good or bad?

And if the pain gets worse again, I'll get back to the ER. The fact that I went before is a reflection of the severity of the pain over 12 hrs.  I NEVER go to the ER.

Obstructions and blockages can be caused by scar tissue after surgery, by intestinal swelling, and by kinking or twisting of the intestine. My blockages after surgery were all due to swelling and scar tissue. I was told I had a lot of swelling after surgery and it took a while to subside. One of my surgeons said my bowels just "blew up" with swelling after being cut. Believe it or not 14 months after takedown isn't that long. And it really took a long time for my bowels to settle after the colectomy.

Of course, it could be something you ate coupled with a physical issue. But I would tend to not suspect the stricture. Also, if you were blocked at the stricture, you would be feeling lots of pain and pressure.

I am just speculating of course, based on my own experience. BTW, you were smart to refuse the fentanyl and it was not a great idea by the ER staff to offer it to a patient who couldn't move his bowels. That definitely would have been pouring gasoline on the fire.

Not sure what to make of the gurgling. Let us know if you have a BM tonight. Try having some soup or tea and see if you can keep it down. Liquids until you move your bowels.

This helps.  Lots of pain and pressure at the ostomy site the first night.  This is different and could be from residual inflammation. CT concluded " Gastric thickening that could be compatible with inflammation versus underdistention."

AMB,

I had an MRI Enterography back in 2012 which showed the same thing- thickening of the bowel wall at the Pouch inlet, due to inflammation. It's similar test to the CT but much longer. I was there for 3 hours.

Ultimately when you get past the issue you may need something in an addition to antibiotics- like Remicade or Entyvio - to control that inflammation. However I would be surprised if it is causing the current issue.

I agree that it sounds like a (partial?) obstruction. I would stick to a fluid diet for some days, there are full caloric drinks containing all nutrients needed. Perhaps even carefully try a laxative. Until you have normal BM again.

My first blockage was several months after takedown, it was (partially) resolved in hospital by a contrast agent with a laxative effect. But I had to deal with abdominal pain after eating for some more weaks, finally doing such a liquid only diet.

Thanks Steve. Very reassuring to hear that the duration of symptoms is not unusual. I'll stick to liquids and find an elemental diet product to carry me.  

I found a great article on diagnosis and management of obstruction, linking here for posterity. https://www.ncbi.nlm.nih.gov/books/NBK572336/

Day 4 since onset and 3 days since I passed any stool.    Staying on clear liquids. Local GI suggested ensure or boost, but I think that would be a disaster.  Still crampy and distended.  
A few weeks ago I would not have dreamed I'd ever miss going to the bathroom  6x daily.

Hang in there AMB. What I can tell you is it WILL eventually pass. I went through 4 blockages including an ileus. They all sucked and all were within 2 years of my surgery, but they all resolved one way or another and yours WILL resolve. Then you will have your scope with Dr. Shen and if there is some issue that may be causing this, he will get to the bottom of it. You have educated yourself with a really good article you posted above.  This is a somewhat common post takedown issue and many of us here have been through it and feel your pain through our own painful memories. I certainly do. Good luck.

I am sorry to hear the pain you are going through. I spent years going through constant obstruction attacks. Most eventually passed after incredible pain. The only pain killer was a morphine based one that disolved under the tongue as all other pills would not be digested and get thrown up.

Numerous times i had to be on IV and diamorphine in hospital.

The last time, after a week of no movement in hospital, they opened me up to have a look. I begged the surgeon to straighten it all out and put the intestine back neatly.

I have not had an obstruction since.

All this caused by having the ileostomy done by an awful surgeon, who threw everything back in,  leaving strictures and filamints all tangled. He was the typical old school surgeon, full of himself, condescending, little care for the patient with a gaggle of trainees around him. Yep, i am still bitter, but the last surgeon, unpacked it all, resectioned damaged parts and put it back neatly and treated me like a human being.

I hope you get it resolved. Ask your local doctor for some decent sublingual pain killers until you get out sorted.

Thanks to all who provided guidance and support.  A call with the (better)  GI in the local group last night ended with a recommendation to try a dose of Miralax in the morning.  It worked.  Still sore and will stay on clear liquids a while more, but the Miralax did the trick to clear the area of obstruction, I think probably entirely.  

If I get any further insights on this from Dr. Shen's group will post here.  But for now - another survivor.

AMB, glad to hear it passed without resort to vomiting, or intubation of the dreaded NG tube. Important question: did you inspect your BM to see if there were undigested artichoke leaves in it? The nature and quality of the BM may have provided some clues on what was causing the obstruction. If not, I am sure Shen's upcoming scope might shed some light.

I only ate the heart of that artichoke and the soft layer of the leaves!  But that was enough.  I wonder, too, if psyllium husk later than usual that day may have added to the problem.  

Dr Shen's NP confirmed that these issues associated with narrowing at the surgical site are pretty common.  Her advice was to stay on clear liquids a few days, advance to regular liquids and then stay on soft foods with no fiber until the procedure 9/6.  And if I run into more problems to head to NY Presbyterian's ER (3 hrs away.). So far ok with intro of some solids.  But the liquidy stool means burning again, and some leaking, things I haven't had to deal with for many many months.    Sigh.