Your thoughts on this...

A friend wrote this morning that the niece of another friend (sorry, but that's what I know) had bypass surgery recently at PA Hospital. She originally went in for lapband but they said her liver was too enlarged so they did gastric bypass instead. Now she's vomiting blood and they can't get it stopped.

First I'm wondering if her liver was that enlarged why they would do ANY surgery of that type - two, did she know they were going to do bypass if they couldn't do lapband and 3 - why the vomiting? I guess the biggest question I'm asking is why the vomiting? Could they have knicked something? I'm trying to find out answers to the other questions from my friend.

Situations like this give RNY a bad name - also, I don't know if they were able to do it lap or had to do it open - I'm guessing that it had to be open if her liver was that enlarged??

Thanks for any insight you can provide.

Pam is off today so hopefully she jumps on and gives us the medical advice.

I would guess that maybe something along the suture line? When was her surgery? If she is still in the hospital then it could have been some kind of a suture issue that was aggrevated by the vomiting. PURE speculation here of course.

I don't get why they would be able to do the bypass and not the band because of the liver - I'm with you they should have stopped in their tracks!

Thoughts and prayers headed out to her and her family!

Here I am!

The vomiting isn't as much of a concern as much as the fact that she's vomiting blood.  Now...there's a few different "possibilities" out here.  One is that it is left over blood from the surgery that is in her pouch and her system is purging it.  This happened to a friend of mine who happened to work in the hospital with me and it terrified her...but once she "got it all up" it was gone.  She did have the post surgical nausea and what not....

The other concern (bigger) is that she is bleeding internally from somewhere at the surgery site.  Suture lines etc.  Basically - she will most likely continue bleeding and vomiting the blood until they go in a fix what ever is wrong.

The whole enlarged liver thing has me a bit concerned, especially with the bleeding.  Liver enzymes help with control of bleeding and ridding of waste products.  So my question is:  why was her liver enlarged?  Was it a fatty liver and just big from fat?  Or was it a diseased liver and now it can't process things right (including any left over blood in her pouch)  If it's the latter, this could cause some serious problems (as if we didn't guess vomiting blood isn't a good sign to begin with)

Now...the whole bypass vs lapband thing.  I hope and pray with every fiber of my being that she knew this was an option going into it.  Eee gawds...if they did bypass on her without her consent...and she is not mentally ready for the even bigger life style changes placed on her by the RNY route as opposed to lap band route I fear she will have a very difficult time coping. I know I would!

And then there's the concern of doing any surgery when something unexpected was found.  Being "born and raised" by pupkova and barix...I know damn well if anything was of concern the surgery would have been stopped right then and there.  Unfortunately so many surgeons and hospitals have a "factory" outlook on bypass patients...it's a paycheck for them...get 'em in, get 'em out, get the next one on the table.  Which is just soooo scary to me.

Ok...so that's my mental ramblings on the subject.  Please please pass along our prayers and thoughts to her and her family.  Of course, any updates you have we'd be interested in!

Pam

I'm waiting to hear back from my friend about this but haven't so far - I know it was really vague information to go on. I can't believe they operated on her either with an enlarged liver - that makes no sense at all.

Thank you (and Liz) for providing some insight - if I get any more info I'll pass it along. Thanks!

I hope your niece's friend will be okay and will send prayer her way and all I have to say is if that were me that it was done to I would have lots of questions and want to know the whole story because my one question is do you mean to tell me no one could tell her liver was enlarged? Sound fishy to me.  I know if the liver has a problem it usually shows up in the bloodwork? Sound like a mess and I hope she will be ok.

In my experience, vomiting blood means that there is a vessel bleeding somewhere in the digestive track. Post op nausea/vomiting is not unusual in and of itself. A person's digestive process shuts down secondary to the anesthesia. It can take a few days for your normal peristalsis( the wave like movement that keeps food/fluid heading north to south) to return. Dark brown/coffee ground like material indicates old blood, bright red/clots indicates a fresh or ongoing active bleed. Unfortunately, bleeding can be a postop complication of any type of surgery, The more difficult the area is to reach and maneuver around, the harder it is to see and tie off all potentially bleeding or oozing blood vessels. Or a ligature may have slipped off of a blood vessel.

It isn't unusual for an obese person to have an enlarged, fatty liver, hence the reason most surgeons have preop diets ordered.Weight loss prior to surgery can help to shrink the size of the liver, allowing easier visualization and access to the operative area. I would assume that the pt. discussed and signed a consent to allow for the gastric bypass if the lapband wasn't doable once the surgeon got a look at that patient's anatomy. It is unfortunate that this person is having these complications, she is likely to face repeat surgery to find and tie off the bleeding vessels.
Chris