Internal hernia into descending mesocolon

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risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Internal hernia into descending mesocolon

Postby risto » Wed Feb 07, 2018 10:56 pm

My DW had a small bowel obstruction on Jan 23. After spending 8 days in community hospital, where we had been told it was either due to adhesion or peritoneal mets, she was transferred to her cancer center and had surgery. It turned out to be an internal hernia into the descending mesocolon, a complication that rarely occurs after low anterior resection. Unfortunately due to the 8 days wait, she had to have 120cm jejunum removed. Hopefully that won't hurt her ability to get nutrition, but I am worried about that. At the community hospital, all they would offer was a palliative care or hospice referral, despite having a ECOG Performance Status of 0-1. It made me so angry. Even if she can't be cured, she has a lot of living to do!
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury

Lee
Posts: 5678
Joined: Sun Apr 16, 2006 4:09 pm

Re: Internal hernia into descending mesocolon

Postby Lee » Thu Feb 08, 2018 12:32 pm

I hope your DW recovers soon. It's a shame she spend time at the local hospital. Is there a reason she was not transferred sooner?

Talk to a nutritionist regarding diet for your DW.

Unless the cancer center is talking about hospice, assume she's not there yet. Sometimes local hospital are not always up on the latest cancer treatment plans.

Keep us posted,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Re: Internal hernia into descending mesocolon

Postby risto » Fri Feb 09, 2018 4:46 pm

It was an issue with coordination of benefits. She is on 3 different insurance and they couldn't figure out who would pay what.
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury

DarknessEmbraced
Posts: 3128
Joined: Sat Nov 01, 2014 4:54 pm
Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Internal hernia into descending mesocolon

Postby DarknessEmbraced » Mon Feb 12, 2018 12:22 pm

I hope your wife's recovery goes well!*hugs*
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17

risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Re: Internal hernia into descending mesocolon

Postby risto » Wed Feb 14, 2018 12:56 am

She is having some post-surgical ascites. They are planning to use interventional radiology to run a line to drain them off. They say this is temporary.
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury

User avatar
CRguy
Posts: 9613
Joined: Sun Feb 10, 2008 6:00 pm

Re: Internal hernia into descending mesocolon

Postby CRguy » Wed Feb 14, 2018 10:21 pm

risto wrote:It was an issue with coordination of benefits. She is on 3 different insurance and they couldn't figure out who would pay what.

Regarding " insurance issues " ... :evil:

Maia had provided this info a while back :
you can ask Laurie Todd to help you: https://www.statnews.com/2016/04/25/insurance-warrior/
She's a fellow of us in Colontown; post your problem and tag her in Downtown, she's a member there too: https://www.facebook.com/laurie.j.todd

... and I had also flagged this with different contacts :
A while back, in regards to appeals, folks had discussed this person, Laurie Todd :
The Insurance Warrior

Healthwise Publications • 12617 N.E. 130th Way, #E301 • Kirkland, WA 98034
email: laurie (at) theinsurancewarrior (dot) com


Best wishes
CRguy
Caregiver x 3
Stage IV A rectal cancer/lung met
11 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Re: Internal hernia into descending mesocolon

Postby risto » Thu Feb 15, 2018 1:28 am

Met with the surgeon and he said that the radiologist noticed something on the CT scanner during the procedure. He said she has Superior mesenteric artery syndrome (SMAS), where the duodenum gets stuck or trapped between the aorta and the superior mesenteric artery, causing blockage of the duodenum. This condition is even more rare than the internal hernia, presenting in about .3% of post surgical cases. They seem to think it will become untrapped after a while, so it's more watching and waiting. She has been in the hospital more than 3 weeks now, so the anxiety is building up.
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury

menreeq
Posts: 66
Joined: Fri Jun 30, 2017 10:26 am

Re: Internal hernia into descending mesocolon

Postby menreeq » Fri Feb 16, 2018 3:26 am

Has your wife lost a lot of weight? Loss of mesenteric fat can cause SMA syndrome. Hopefully putting some weight back will help.

Take care!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17), 0.8 (2/28/18)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Xeloda monotherapy 8/13/17-1/22/18
PET/CT 3/21/18 NED

Sara!!!!
Posts: 51
Joined: Wed Jul 19, 2017 9:57 am

Re: Internal hernia into descending mesocolon

Postby Sara!!!! » Wed Feb 21, 2018 1:18 am

risto wrote:My DW had a small bowel obstruction on Jan 23. After spending 8 days in community hospital, where we had been told it was either due to adhesion or peritoneal mets, she was transferred to her cancer center and had surgery. It turned out to be an internal hernia into the descending mesocolon, a complication that rarely occurs after low anterior resection. Unfortunately due to the 8 days wait, she had to have 120cm jejunum removed. Hopefully that won't hurt her ability to get nutrition, but I am worried about that. At the community hospital, all they would offer was a palliative care or hospice referral, despite having a ECOG Performance Status of 0-1. It made me so angry. Even if she can't be cured, she has a lot of living to do!

Hi I just wana ask you that when they opened ur wife, did they do debulking too?
Daughter to mom 67, colon cancer
Diagnosed Dec 16, bowel obstruction.
Hemicolectimy done,Dec 16.
4 lesions in liver on scan before chemo jan 17.
Folfox +Avastin 12 cycles,disease progression on pet Aug 17.
Attempted liver resection, failed. Mets peritoneam. Diffuse.
Mets to lungs, liver. Peri on scan Nov 17.
3 cycles of folfiri+ cetuximab. Cea down from 888 to 383.
Small bowel obstruction jan 18

risto
Posts: 54
Joined: Wed Jan 06, 2016 2:28 am
Location: USA

Re: Internal hernia into descending mesocolon

Postby risto » Thu Feb 22, 2018 12:43 am

No, they didn't do any debulking, only took some biopsies. They tested positive for PC but there was not much of it there, apparently because the chemo has been working.
DW Dx 7/15, 41 yo, st IV, 3+ liver mets: 11.3 cm, 7cm, 3cm. MSS.
KRAS, APC, SMAD4, TP53 mut.
7/15-10/15: FOLFOX+bev. x8
11/15-12/15: SIRT (Y90)
1/16: Toxic Hepatitis, chemo break
4/16: Liver resec. fail
5/16-7/16: FOLFIRI x6
8/16: Liver resec.
8/16-11/16: FOLFIRI x6
2/17: IMRT/Xeloda x25
4/17: LAR
6/17: CT: Progression. Peri, Lung, Liver mets. FOLFIRI x6
9/17: FOLFIRI+Bev x5.
11/17: CT: Stable. 5FU+bev. maintenance x5
1/18-2/18: Surgery for SBO
5/18: ascites, acute liver injury


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