Following colon surgery, swelling in the lower limbs or around the groin may be observed. In some cases, the swelling becomes extreme, with the limb or limbs affected feeling unusually heavy. Although diagnosis can initially be uncertain, this is likely to be a condition called lymphedema caused by damage to the lymph nodes during surgery. It can be long lasting and difficult to treat, as further surgery can cause further damage to the lymphatic system.
The colon is part of the large intestine, the length of gut which absorbs water and nutrients from food before it passes into the rectum where it is ultimately expelled as waste. Colon surgery (colectomy) most commonly occurs in cases of colon cancer but can also be used to treat ulcerative colitis. The purpose of surgery is to remove the section of colon where a tumour has been detected, leaving only healthy tissue. In anastomosis, the healthy sections of the colon are reconnected using sutures or staples, restoring the function of the intestine. Alternatively, in colostomy, the part of the colon descending from the stomach is connected by tube to an external colostomy bag which collects fecal material.
The Lymphatic System
The lymphatic system is part of the body's immune system. Consisting of lymph nodes and the lymph vessels which connect them, the lymphatic system helps defend the body by attacking cancerous cells and bacteria. When lymph nodes are removed or damaged, lymphatic fluid can accumulate in the local tissue, especially in the lower limbs, leading to heaviness, extreme swelling and discolouration of the skin.
One side effect of colon surgery is swelling in the limbs caused by lymphedema. Lymphedema results from damage to the lymph nodes, which can occur during a colectomy. The onset of lymphedema is gradual, usually beginning with vague symptoms of heaviness in the limbs. The condition is usually diagnosed by observation of the size of swelling as it develops. It is also possible to measure the build-up of fluid.
Non-intrusive treatments of lymphedema include massage, light exercise and wearing compression garments. In more severe cases, lymphatic fluid may be drained from the affected area. The bulky tissue trapping the fluid can be removed through invasive surgery, but this runs the risk of causing further damage to the lymphatic system and making the condition worse.
Other Causes of Swelling
Other possible causes of swollen limbs include circulation problems possibly related to inactivity after surgery, or veinous obstruction due to blood clotting. Initially it may be difficult to distinguish lymphedema from other forms of swelling.