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Adhesions Can Cause Colon Blockages; Abcess Can Cause Colon Fistula

Dear Drs. Donohue and Roach: My 85-year-old wife had a benign ovarian tumor removed in 2008. During a vacation in Florida the next year, she had a bowel blockage. The treatment was insertion of a tube through her nose and into the stomach. The doctors said the blockage was caused by adhesions from her prior surgery. She had another blockage in 2010, and another six months later. It was decided that an operation to remove adhesions was necessary. The surgeon indicated that he had used a spray to prevent adhesions from re-forming. However, she had another blockage in March of this year. Are there other treatments for obstructions caused by adhesions? — P.B.

Answer: Adhesions are bands of scar tissue that form from abdominal organs and tissues when a surgeon opens the abdominal cavity. Virtually everyone who undergoes abdominal surgery forms adhesions. Not everyone, however, has a bowel obstruction due to adhesions. The obstruction occurs when scar tissue wraps around the colon.

When that happens, an attempt to decompress the colon often brings relief. It’s done as you indicated, with a tube passed through the nose and into the digestive tract for the removal of partially digested food and liquids. Those foods and liquids build up pressure within the colon. Evacuating the colon relieves the high pressure, and pain stops. In some instances, like your wife’s, the encircling bands of scar tissue have to be removed in order to reduce the pressure within the colon.

Attempts to minimize adhesion formation include the spray your wife’s surgeon used. Special sheets that are similar to wax paper also can prevent adhesion formation. The sheets are absorbed in a week or so. Nothing works 100 percent of the time.

Laparoscopic surgery, done with small incisions and little touching of the abdominal organs, lessens the chance for adhesion formation. I sincerely hope your wife has no more adhesion troubles.

Dear Drs. Donohue and Roach: Please explain colon fistula. A friend has one, and stool leaks through it. What can be done? —Anon.

Answer: A fistula is like a tunnel that connects one organ with another or with the skin surface. Your friend has an anal fistula; this friend’s tunnel connects the inside of the colon to the skin near the anus. Fecal material leaks through the fistula. Most fistulas arise from an abscess within the colon. The bacteria in the abscess burrow a tunnel that opens on the skin. Treatment is directed at eradicating the abscess and opening the tunnel so it heals on its own.

Dear Drs. Donohue and Roach: I am an 86-year-old man and was told to cut down on my salt intake. There is a product called No Salt available in grocery stores. I can’t tell the difference between it and regular salt. Your comments? — W.D.

Answer Regular salt is sodium chloride. It’s the sodium that does the dirty work of raising blood pressure. You have a salt substitute. It’s potassium chloride. It does taste like sodium chloride, but it has no sodium.

Let your doctor know you’re taking it. People with kidney disease or those who take a medicine called ACE inhibitors or those who take a water pill that leads to potassium retention should not use a potassium salt substitute, as their blood level of potassium can rise to a dangerous level. If none of this applies to you, you can safely use a salt substitute.

In the best of worlds, it’s better to lower your salt intake (sodium chloride) by reducing the salty foods you crave and retiring your saltshaker. In a matter of months, people get used to a low salt intake. When they eat food in a restaurant or at a friend’s house, they have to wince when swallowing it. The food tastes far too salty for them.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.