tarry stool after colostomy &ileostomy?

[romantic, BSN, RN]

Sorry for mistake in the name of the post. Should be Colectomy instead of colostomy.

Tarry stool a week after subtotal colectomy and ileostomy?

I work on med floor my first year and would be very glad to hear from experienced nurses. Three nights in a row I took care of an elderly. The man had history of multiple admissions to the hospital with GI bleed. This time he had subtotal colectomy with ileostomy a week ago. On first night he c/o pain every hour even after administration of dilaudid 0.5mg, iv. His abdomen was flat and guarded by pt to palpation. Ileostomy bag was intact, draining green liquid like stool, moderate amount. Medication was given every 2 hr according MD's order. Pt was still c/o pain. VS were stable. But I called a rapid Response nurse anyway just to be sure that I am not missing something. Second night he refused to take any pain medication. Pt was on clear liquids diet. On third shift, around 4 am my CNA told me that she thinks he had stool. I found a pad and it was tarry stool. I assessed pt the was pasta like tarry discharge around his anal area. We cleaned him about 4 times. Overall, the amount was about 500-800 cc of tarry pasta like stool. Pt was on regular diet for whole day.

Can a pt have a tarry stool a week after subtotal colectomy with ileostomy?

Thank you for your input:loveya:

[Up2nogood RN, RN]

Now I've seen various types of drainage come from the rectal area but not usually stool since the patient has a bowel prep before surgery. It's possible that it could be old stool/old blood if the patient didn't have a bowel prep before surgery. Either way, I'd give the doc a heads up on what's going on. It's amazing what pearls of wisdom they may have but prefer to make the nurses sweat by not passing on the info.

[romantic, BSN, RN]

I called MD in am to inform her regarding the situation. She wanted to d/c the pt to SNF that morning but after my call she decided to keep the pt in the hospital for a while to monitor his condition.

Well, the pt was No code.

I just was surprised to see stool after colectomy and ileostomy. Is there still a passage left for stool to go through? If the pt was only one day on regular diet, how, Good Lord, he could have this stool -- he also didn't eat well.

He came with GI bleed . If he wasn't prepped for the surgery, it could explain the tarry stool...

Thank you.

[Up2nogood RN, RN]

There shouldn't be a passageway for new stool to go thru unless there is a leak or fistula of some sort and if that was the case I would suspect you would see some abnormal s/sx. I found it helpful to review different types of bowel surgeries, abnormalities can differ depending on the area of small intestine or bowel resected.

But it sure sounds like he wasn't prepped at all or just not very good. Frequently we get our elderly surgical patient the night before to ensure their prep return is pretty near clear before surgery.