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The first step of my 2-step surgery (IPAA) was performed on 20th Sept. 2012. Everything was normal and started feeling good about it. After 10th Oct I resumed normal activities. Immediately I started feeling some stress. But my doctor gave a green signal for everything. I drove to-and fro to my institute where I work as Associate Professor. I taught all my classes everyday. I felt exhausted after the teaching schedule. I thought my body needed rest but continued with my active life.

After a few days I started noticing small streaks of blood in the stool that I was passing through anus. Recently the amount of blood has increased. My urge to pass stool through anus has also increased. I understand that passing of mucous and stool through anus before take down surgery is quite normal but passing of blood is not "normal".

A recent test called Pouchogram showed that my pouch is normal.

1. Is it possible that there is a problem but it is so unnoticeable that it escaped the attention of the doctors who performed this test?
2. Is there any other test to find out what is going on?
3. Is it normal to pass some blood before take down?
4. What could be the possible cause?
5. Does it mean that I am heading towards pouch failure and permanent ileostomy?

My doctors is relying too much on the findings of the Pouchogram;
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so sorry to hear what you are going through.
Here's the lowdown on tests:
a pouchogram is just a barium enema into the pouch. This test is generally used to see if there are leaks in the pouch.

a pouchoscope - is like a colonosocopy. they put a camera up into the pouch so the doctor can really see what is going on. They can see if there is inflammation or things like that.

a MRI- at your stage - most often used to see if there is some kind of abscess brewing somewhere in your pelvis.

CAT scan - can also show problems with the small intestine - like some blockages or inflammation. sometimes they are used to hunt for abscesses also.

So in your case... I would be pushing for a pouchoscopy. Get your doctor to really look up in there. Wondering if you have some kind of stricturing? Or also if you maybe just have cuffitis (inflammation of the remainaing part of the rectal cuff). This would be seen on a pouchoscopy. Cuffitis is generally easily treatable.

good luck.
I had a 3-step procedure and had blood and mucus during the entire time I had an end and a loop ileostomy. It's UC in the retained cuff. I was given cortifoam which did nothing. However, I was cured.... when I had my takedown surgery. I think that happens for a lot of people.

Life with ileostomy is absolutely no indication of life with a functioning j-pouch. Not to worry.

In my opinion, both mucus and blood are normal for some of us. If this is too much a problem for you, you might ask your doctor if step two can be moved up.

kathy Big Grin
Many Thanks Liz11 and Kathy Smith for your prompt and helpful advice.

Someone told me that "bleeding before take down" could be an indication of cuffitis. If it is so, I would have to take same medicines i was taking for UC for the rest of my life.

I was also told that there is a procedure called mucosectomy whereby the rectal cuff is stripped of UC cells. This removes the risk of cuffitis. However it is a delicate procedure and if not done properly, it can lead to the problem of continence.

I wish Kathy Smith's experience turns out to be true for me , because mucosectomy cannot be done at this stage (the decision should have been taken earlier, i.e., at the time of creation of J pouch).
According to my surgeon (one of the top colorectal surgeons in the country at a well-known teaching hospital), mucosectomies are not really ever done any more. They were more common back in the early j-pouch days when more of the cuff was left in tact, but now, especially since the introduction of the double-stapling technique that has cut way down on complications and issues, they try to leave as little cuff as possible to prevent cuffitis (in my case less than 1cm) - just barely enough to staple the pouch to. Of course it's possible some surgeons are still sticking to older procedures.

The point is that scraping it probably would not have made much of a difference and could have caused more problems than good, since it is common to also scrape away nerve endings along with it that are used for continence.

Do you know how much of your cuff was left? There may not have even been enough to scrape...
Thank you bootstrap

My surgeon says he has left 2.5 cm rectal cuff. In his view it is impossible to do with less than 2 cm.

He has no idea about blood in stools before takedown. But he says "no problem." (perhaps because it is not 'too much').

Kindly note that my system was not cleaned (flushed) before surgery, though the doctors had the time to do this because my surgery was elective. Is it possible that the present complication is the product of poor preparation?

Is it possible to prevent cuffitis and pouchitis and live without constant fear of getting these kind of complications. I had the assumption that after surgery I'll live without fear. ( In UC years I lived under constant fear of relapse).
quote:
Is it possible to prevent cuffitis and pouchitis and live without constant fear of getting these kind of complications. I had the assumption that after surgery I'll live without fear.
It's probably not completely possible to prevent either but it is possible that you'll never have either. One thing that has been discovered is that taking NSAIDs can lead to pouchitis, so try to avoid them. Also, ingesting pro-biotics can help. I've never had either pouchitis or cuffitis. Some people have a bout or two of pouchitis which is cleared up with antibiotics and then all is good.

I eat sourdough toast every morning which has very mild pro-biotic qualities.

But living in constant fear of getting pouchitis or cuffitis is like living in constant fear of an earthquake or heart attack. It could happen, but you probably don't live in fear of the thought of either. There are things you can do to help prevent a heart attack and there are ways to make your home as safe as possible from an earthquake but there's nothing to prevent them.

So be happy. Don't worry....

kathy Big Grin

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