Pancreatitus after mini gastric bypass

Question
My daughter is 5 weeks post op (mini gastric bypass)and has been diagnosed with pancreatitis.  She is currently in the hospital, several tests have been run and no cause has been found.  She has had a CT, MRI and two ultrasounds.  Her daily blood work indicates her lipase has been over 1,000 since her admission four days ago and it is not decreasing.  Ten days prior that she went to the ER and was treated for dehydration and at that time her lipase was 20 points over normal and the ultra sound showed her pancreas was slightly inflamed.  The doctors here in Michigan said they have ruled out pretty much everything except the surgery as a cause.  The gastroenterologist suggested an upper GI, but she could not keep down the liquid required.  There is some speculation that he will be putting a scope down her throat to see if he can find a cause.  If nothing is found with the scope, they are going to assume the surgery caused it and the doctor said a surgeon here in Michigan is unlikely to do exploratory surgery on her unless she is in dire straits.  They are telling her to go back to the surgeon who performed the surgery, but he is in Mexico and if he did do something wrong I do NOT want him operating on her again. Can you think of some other test I can suggest they do or refer me to a surgeon in Michigan that would be willing to take on her case and do surgery if necessary to find out what is going on?  The doctor here just wants to get some food in her so he can send her home, regardless of her lipase #'s.

Answer
Hi Marilyn:

Sorry it took me a few days to get back to you.  You must be so worried.

First off, there is an increased risk of pancreatitis with gastric bypass... be it Roux-en-Y or the Mini-Gastric Bypass.  Is it related to the increased risk of gallstones from rapid weight loss? Perhaps--I'm not sure if that's been proven to be the cause or if they feel it may be related to something else.  I know with the RNY, there's a risk of obstruction of the duodenal limb which can mimic pancreatitis. (That can be evaluated via CT and DISIDA scan.)

Was your daughter on Actigall following her surgery to prevent gallstones?

There is a group that does the MGB in Michigan... I believe they are near Bay City.  You want to contact Dr. Paul M. Doroghazi, 200 South Wenona Street Suite 195 Bay City, Michigan 48706.  If he is unable to help, you have two options.

1) Contact Dr. Robert Rutledge---who is the pioneer of the MGB. He's in Las Vegas.  You can get his contact info at www.clos.net.

or

2) Contact any experienced bariatric surgeon in Michigan.  I'm not sure where you are, but there are quite a few good ones in the State. A few names that come to mind: Dr. Paul Kemmeter in Grand Rapids, Dr. Mustafa Hares in Auburn Hills, and Dr. Marek Lutrzykowski in Bloomfield Hills.  If you're in South Michigan, you may want to consider Dr. Brian Lane in Bowling Green, OH.  Of course, if you're super nervous, you're not too far from the Cleveland Clinic--which has an excellent bariatric program as well.

I really don't know if reversing the surgery would remedy the pancreatitis, to be honest.  But you should be able to speak with a bariatric surgeon and find out.  At minimum, one should be able to consult with your daughter's gastroenterologist to help find a solution.  (Even the guy in Mexico should be open to this.) Just please, if you are facing a revision/reversal of the surgery, make sure you are dealing with an experienced revision surgeon.  

Sorry I can't offer anything more.

I hope your daughter is better soon.

Karla  

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