Our Summary

This research paper talks about a case where a patient was brought into the operating room because the doctors thought she had a dead (necrotic) small intestine and colon. However, during the surgery, they noticed that the patient’s colon was black but still seemed to be alive (viable). They decided not to remove the colon as they had originally planned. Later, they found out that the patient had melanosis coli, a harmless condition that causes the colon to turn black. The patient revealed that she had been taking a herbal laxative, components of which are known to cause melanosis coli. The authors hope that this case will remind doctors and surgeons to consider melanosis coli when they see a patient with a black or dark colon. They also identified similar cases from the past and suggested several factors to help doctors make decisions during surgery. The key subjects of the paper are drugs related to the digestive system, gastrointestinal surgery, general surgery, and unwanted or adverse drug reactions.

FAQs

  1. What is melanosis coli and what causes it?
  2. How can the appearance of melanosis coli affect surgical decision-making during bowel resection?
  3. What factors should be considered during intraoperative decision making when melanosis coli is discovered?

Doctor’s Tip

One helpful tip a doctor might tell a patient about bowel resection is to follow post-operative instructions carefully, including taking prescribed medications, eating a healthy diet, staying hydrated, and avoiding strenuous activities until fully healed. It is also important to attend follow-up appointments to monitor healing and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended bowel resection include those with conditions such as:

  1. Colon cancer
  2. Diverticulitis
  3. Crohn’s disease
  4. Ulcerative colitis
  5. Bowel obstruction
  6. Intestinal perforation
  7. Ischemic bowel disease
  8. Severe gastrointestinal bleeding

It is important for surgeons and clinicians to carefully evaluate each individual case and consider the potential risks and benefits of bowel resection before making a recommendation for surgery. In some cases, alternative treatment options may be considered based on the specific diagnosis and overall health of the patient.

Timeline

Before bowel resection:

  • Patient experiences symptoms such as abdominal pain, bloating, changes in bowel habits, and possibly rectal bleeding.
  • Patient undergoes diagnostic tests such as blood tests, imaging studies (CT scan, MRI, colonoscopy), and possibly a biopsy to confirm the need for surgery.
  • Patient meets with a surgeon to discuss the procedure, risks, and benefits, and prepares for the operation by following preoperative instructions.
  • Patient undergoes bowel resection surgery, which involves removing a portion of the colon or small intestine affected by disease or injury.

After bowel resection:

  • Patient wakes up in the recovery room and may experience pain, nausea, and fatigue.
  • Patient is monitored closely for complications such as infection, bleeding, or bowel obstruction.
  • Patient gradually resumes eating and drinking, and may need a temporary colostomy or ileostomy to allow the intestines to heal.
  • Patient undergoes follow-up appointments with their surgeon to monitor healing, address any concerns, and discuss long-term care and lifestyle changes.
  • Patient may require physical therapy, dietary changes, and ongoing monitoring for potential complications such as bowel obstruction, malabsorption, or changes in bowel habits.

What to Ask Your Doctor

  1. What is the reason for the bowel resection surgery?
  2. What are the risks and potential complications associated with bowel resection?
  3. What is the expected recovery time following bowel resection?
  4. Will I need a colostomy or ileostomy after the surgery?
  5. What dietary changes will I need to make after the surgery?
  6. Will I need any additional treatments or medications following the surgery?
  7. How will bowel resection affect my quality of life in the long term?
  8. Are there any alternative treatments or procedures that could be considered instead of bowel resection?
  9. What is the success rate of bowel resection for my condition?
  10. Are there any lifestyle changes I should make to improve the outcome of the surgery?

Reference

Authors: Hubbard G, Prusko R, Christopher J, Russ R, Chlysta W. Journal: BMJ Case Rep. 2022 Oct 25;15(10):e250062. doi: 10.1136/bcr-2022-250062. PMID: 36283740