trouble with stomach surgeries

Question
QUESTION: I had weight loss surgery with staples going across the stomach in 1981 at age 14. Then I had a revision in 1984 with a band that didn't tighten or loosen. In 2005 I had them reversed due to scar tissue and not keeping food down. After this, I was told that my vagus nerve was cut and so I had slow mobility. I had a subtotal colectomy to help with that, which did and also a gastric bypass which helped. Still after I eat though, I feel food slows in the lower right side of my belly. Last night I was in the ER with what I believe was some sort of obstruction. They found nothing and I have no gallbladder or appendix and kidneys and everything looks fine. I was in HORRIBLE pain. I've had a small intestine test before my colectomy and gastric which just showed slow mobility along with a sitz marker test which showed that too. My question is, could I have a narrowing where food stops at times and after a few hours moves through this narrowing? I tend to always have bloating in my lower right abdomen after I eat, but it's never been that bad, but I do get similar pains. They just don't last like that did. When I eat, I feel I can press on my abdomen and feel the good gurgle through. What type of test might show a narrowing? Should the small bowel follow through have shown a narrowing? Thank you for being here for people. This is such a wonderful thing you do to help other people. I very much appreciate you.

ANSWER: Stephanie,
I regret to say that, with your history of multiple surgical procedures, this is likely to be difficult problem to diagnose and to treat.  I will give you a few thoughts, but the real answer is that you need to be seen by an experienced bariatric surgeon or experienced general surgeon, or maybe colorectal surgeon.

The tests that are most likely to be helpful in a case like yours are CT scan of the Abdomen and Pelvis, and Upper GI with Small Bowel Follow Through.  I get the sense that both of these have already been done in your case and I gather they were normal.  Unfortunately, most of our tests can show your anatomy (the shape of things) but not your physiology (how the intestine moves and works).  Since you have previously been diagnosed with a motility problem, it seems reasonably likely that your current symptoms are caused by a motility problem (physiology) rather than a kink or fold in the intestine (anatomy).

The problem is that we have very limited tools to treat problems with GI motility, but before settling on that you need to visit with an experienced surgeon who can review your symptoms and look at your available pictures.

Best wishes,
Dr JP

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr JP. It's so tough, because doctors don't want to touch me anymore, because I've had previous surgeries. At the same time I have so much pain at times and bloating that really has caused me to not live a normal life. So I just hate to give up trying to find an answer that might help. It really seems like there's a place in my small intestine that narrows, because after I eat, I can try and push on that area to move it through that place and I hear gurggling in my tummy. This really isn't a follow up question as I know I need to go see my gastric bypass surgeon as he seems the best to talk to about this. He knows robotics, so maybe he can do something as I know scar tissue is such an issue. It just seems like all the tests have you fast and so a narrowing wouldn't ever show up. They also use liquid or something very soft which will go through. I can't touch meat or even peanut butter. I wish the other night they would have been able to find the problem while I was in such horrible pain. Thank you again so much for listening and giving me your thoughts and suggested direction to take. Again, I really appreciate you!!

Answer
You are right about doing testing while you are having pain.  Sometimes the problem area can be "caught in the act."

I did not specifically address it in my last reply, but usually the (liquid only) Small Bowel Follow Through does show a partial narrowing even if it only becomes truly blocked when one eats solid foods.

Best of luck you, and don't give up,
Dr JP

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