UPDATE- And a warning!!!!

Ray asked that I update you when I can, but sitting in the chair is pretty painful still, so I have to keep it short/or do it in one shot. Feel free to share what you wish with anyone who asks. Pardon the "form letter"... while I wrote this for the RNY board, this applies to any and ALL people who sustain large amounts of weight loss.
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My gallbladder surgery was easy and went well, but four days later, quite by coincidence, I developed an internal hernia, which more or less tried to kill me. My hernia specifically involved a loop of intestines pushing inside my excluded stomach that strangulated and is apparently extremely dangerous and often deadly.

 

From the 'net: "A Petersen’s hernia and must be treated surgically on an emergency basis. When a patient loses a significant amount of weight, the fatty tissues in the abdomen decrease in size.  In some patients, the position of the intestine can shift within the abdomen and become twisted and obstructed. 

If you should develop abdominal pain you must seek medical attention immediately.  Petersen’s hernia can be successfully treated and full recovery is to be expected.  Time is of the essence however.  If there is a delay in diagnosis and treatment beyond a few hours, there is the potential for loss of a significant portion of the small intestine and even death." 

 

My gallbladder came out Thursday and by Friday PM I was shopping with my Mom. Saturday morning I developed extreme pain and tried to vomit but nothing would come out. This happened repeatedly throughout the day, even on fluids. By midnight, I could swallow ice chips so we decided I was doing better. I dulled the pain with the Dilaudid they'd given me for the gallbladder and assumed this was some late-developing gallbladder surgery problem. I called my surgeon and his assistant-- neither could be reached by pager. The on call resident told me to go to my local ER for fluids if the vomiting continued.

 

Sunday, I was again able to swallow ice. My mom needed to return to work in Virginia, so I said I felt fine and sent her on her way. By 5 pm Sunday I was in agonizing pain. Again I tried to contact the surgeon, but with no answer. I drove myself to my local small hospital emergency room, literally shrieking in pain...and was still made to wait 4 hours in the waiting room, even though I explained I was a bypass patient and probably in danger of a small bowel obstruction. I received no pain meds until 1 am, and then two bags of fluids. I was literally in and out of consciousness until they let me leave at 6 am00 they said the CAT scan showed some loose peritoneal fluid but since I'd recently had surgery they could not tell whetheror not this was normal.

 

Monday I picked up pain and nausea meds and slept all day. A several points the pain meds (Dilaudid) did nothing so I just stuffed a towel in my mouth and screamed.

 

On Tuesday, my surgeon had returned my call, and read him my labs to see if I had a bile leak-- but I didn't. I had an appointment (post op) to see him the next day at 10am.

 

That night the screaming pain continued-- I had been trying to eat, all the while with a completely onstructed bowel. Dangerously, I doubled up on my pain meds just to get through the night. I have never before had such searing pain. I was awake most of the night and made my appointment at 10 am.

 

The doctor seemed puzzled, but offered to admit me and seemed surprised when I took him up on it. I was admitted at 3pm Wednesday. By 5 the pain was back and I was bawling. My urinary output slowed to almost nothing, my urine turned dark brown. It wasn't until 3 am that I finally got a second CAT scan.  I lay in the hallwy after it at 4am howling in pain, with no answes and no help-- finally at 5:30 they wheeled me back and started IV pain meds.

 

The doctor came in very quickly the next morning. "We saw something we really do not like" was all I remember him saying. I was in tremendous pain and barely conscious at that time. Ray came immediately,and my poor Mom jumped in the car and came back up here while I was in emergency surgery.

 

They tried to look around laparascopically, just as they did the gallstones and the RNY, but couldn't, so I was opened from the sternum to my navel. What they found was the twisted bowel which they set straight and tacked down-- both Dr. and Laurie were shocked not to find dead bowel, but healthy looking bowel tissue was immediately restored. Bowel function was not, however-- so they closed me up and took a "wait and see" stance.

 

I have never ever ever had this kind of searing pain. No bowel sounds means no gas moves, no food moves, and my kidneys were blocked as well. It's like having four kidney blockages at once, while having a caesarian, all done with a serrated steak knife-- and this was only 4 days after my LAST surgery, so I was absolutely exhausted and in misery, I won't lie. Drugs didn't touch it for the first three days. I did a lot of sweating and trying not to kill people.

 

Sunday-- my 4th day, they finally heard some bowel sounds. Gas started to move in my belly-- I was SO relieved to hear signs of life. My doctor said I could go home if I could get some bowel noise and get the pain under control. By Tuesday I was home, but have been in a lot of pain since, so haven't felt much like communicating except what I've had to do to end the school year in my absence.

 

Yesterday, I was able to have a bowel movement (TMI, I know) for the first time in 15 days. I actually wept, because I know now that my bowel didn't die, that it's all going to work out. This is MUCH closer to dying than I ever want to be again. Now I just have to kick this pain, which may take a while, since I've been gutted like a fish.

******It is important that you be aware of this condition. If you develop abdominal pain, you must immediately seek medical attention and inform your physician that you have undergone gastric bypass surgery.  You should also tell them that you have been informed about the potential for a Petersen’s hernia and wish to be examined by a surgeon on an emergency basis. 

While the incidence of this condition is relatively low (less than 5% of patients who have undergone gastric bypass surgery), it is a serious development that must be treated very quickly.

In my case it was hard to figure this out as it seemed like a weird complication of my gallbladder, when it's actually more or less unrelated. If it'd come out of the blue, I like to think I'd have been more insistent on immediate and appropriate care.

DO NOT assume it will get better
DO NOT assume emergency personnel know enough to help
DO NOT waste time in seeking treatment
DO NOT take "we can't get your surgeon on his pager" for an answer if you're post-op
DO NOT keep eating or drinking if you suspect a blockage

And for those of you thinking, "Well, you haven't been able to eat in three weeks, so at least you have weight loss on your side, right?"...... I gained 24.5 pounds.  Seriously. 

Pain is temporary. Intestines are forever. Glad to have the latter even at the expense of the former. Things can get better now.

Wow.  All I can do is sit back and stare at the screen and think of  the pain you must of went through.  I'm so sorry you had to go through that.  That is just awful.  Thank God that you went back and they  finally figured it out.  I can't believe it took that long for them to figure it out.  I'm so glad you went in when you did.  Shame on that doc for making it an option to be hospitalized, but glad you took it!! Take care of yourself. (((HUGS))) Holly

VERY SCARY to think this can happen and no one will listen or find the cause for such a length of time!!!  Thank God your outcome was a positive one.  I'm so sorry you had to experience all that pain!  My prayers are with you that all goes smoothly from here on in. Don't fret for a moment about the weight gain....that is so common following a hospitalization and surgery and such....they pump you full of those fluids and your body has been through such stress....it will come off quickly. REST and take good care of yourself....so glad you are still with us.  God bless you!! Sherrie

Goodness,  I am so sorry that you had to go through all of that.  I could not even imagine.  You poor thing.  Thank you for letting everyone know.  That is crazy scary.  I hope you take care of yourself and get some rest.  Thank goodness they were able to find the problem and fix it and things will be ok for you, internally.  Rest up!!

OMG, Shari.. my heart truly goes out to you.  This was quite a close call and I pray for your complete recovery and comfort. God bless you for sending out the warning even though you are so distracted by so much pain. All love to you, sweetie.. Get well soon!! Lori

Aww Geezus, Shar... I don't even know what to say. Feel better and get well soon!

Thanks for the update Shari. I know that was painful as hell!  I don't think I could have made it through all of that. I'm glad to see you at least are nearing the end of this.  Do you think perhaps this twisted bowel may have been cause of your many poop issues?

Nah. That's dehydration and it's my own damn fault. I *was* finally keeping up with it though, before this happened. Now things seem (knock wood) to be much looser and easier-- but I have been on an all liquid diet for 3 weeks as well. I can tell you that finally getting rid of three weeks of poop makes for some Guiness book experiences, though.

Lol!  Sweet! Did you take pictures to send into Guiness?

I'm just so happy you have some relief from all of that discomfort and horrible pain, Shari.. Amen...   Go on.. call Guiness and give 'em the scoop on the poop!!