Thank you

I'm glad you are OK, very very scary.

I think the next time things are "slow" in the ER? screaming is a good idea.  you know, as a perfectly good symptom of what is happening.

Girl, I was hurting too bad to scream.  I could barely take a deep breath.  It was scary...

Clinical Pearls for Emergency Care of the Bariatric Surgery Patient

A while back someone shared this link from the American Society for Metabolic & Bariatric Surgeons:  http://asmbs.org/poster.html

I'm printing a copy of this TODAY to have in my wallet and also saving to my thumb drive to keep on my key chain. 

I'm also ordering a copy of my original operative record so that if I am out of town and there is an emergency, they will know my anatomy and how to treat me.

Glad you are still with us.

Me too!! 

I went on and off with this type of abdominal pains FOR WEEKS....I even came home early from a SCUBA diving trip to Mexico and went straight to the ER! After every test known to man, and repeated visits to the ER and admissions to the hospital I FINALLY agreed to exploratory surgery. Conclusion:

Petersen's hernia. Part of my intestines was intermittently bulging thru a tear in my mesentary and causing on/off abdominal pain, the worst pain I've ever had IN MY ENTIRE LIFE! If not treated, it can lead to bowel necrosis and death, peritonitis, septacemia and DEATH.

If it happens again (and it may....mine went on for WEEKS), do not mess with it....ask for exploratory surgery and GET IT FIXED.

FYI: mine happened at 4 years post op; then I had a bowel obstruction at 6 years post op.

  Thank you for the information.  

Surg Obes Relat Dis. 2009 Sep-Oct;5(5):565-70. Epub 2008 Nov 18.

Internal hernia at Petersen's space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure--a single surgeon series of 1047 cases.

Bauman RW, Pirrello JR.

Carolina Weight Loss Surgery, Concord, North Carolina, USA. [email protected]

Abstract

BACKGROUND: Recent reports describing a gastric bypass technique and the need for closure at Petersen's space using an antecolic antegastric laparoscopic method have differed in the incidence of internal hernia. We report a 6.2% incidence without closure of Petersen's space in a 1047-case, single-surgeon practice.

METHODS: The data from 1047 patients undergoing antecolic antegastric gastric bypass between January 2001 and December 2006 were prospectively collected and retrospectively evaluated for formation of an internal hernia at Petersen's space. All cases were performed by a single surgeon using an antecolic antegastric technique without closure of the mesenteric space and with division of 5 cm of small bowel mesentery. The biliopancreatic limb length was created at 50 cm during the first 2 years of the study and then at 50 or 100 cm depending on the patient's body mass index.

RESULTS: Of the 1047 patients, 73 underwent laparoscopic exploration for varying degrees of abdominal pain, unexplained nausea or vomiting, or radiographic evidence of an internal hernia. Of the 73 cases, 65 were Petersen's space hernias, for an incidence of 6.2%, 7 were mesenteric enteroenterostomy hernias, for an incidence of .7%, and 1 was negative for intra-abdominal pathologic findings. A direct relationship was found between the biliopancreatic limb length and the frequency of biliopancreatic internal hernia formation (P = .0194), and a high rate of false-negative radiographic reports were noted. Subsequent to these 1047 patients, we have had no internal hernias with space closure in 339 cases.

CONCLUSION: Closure of Petersen's space is important in preventing the morbidity of reoperation and the incidence of internal hernia.

PMID: 19342309 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/19342309



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Abdom Imaging. 2011 Apr;36(2):126-9.

Petersen's hernia as a complication of bariatric surgery: CT findings.

Ximenes MA, Baroni RH, Trindade RM, Racy MC, Tachibana A, Moron RA, Funari MB.

Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil, [email protected].

Abstract

Referrals for bariatric surgery have currently increased due to the need for more effective interventions in the management of severely obese patients. The Roux-en-Y gastric bypass is currently one of the preferred procedures, and internal hernias are the main causes of late postoperative complication. Petersen's hernia is a less common finding in most published papers compared to transmesocolic hernia, however, it seems to be increasing in incidence (in our service, eight cases which have been tomographic diagnosed in 2 years, were confirmed by laparoscopic surgery). The clinical findings are not specific, usually with abdominal pain, associated or not with abdominal distention and vomiting. In this context, imaging exams have an important role in the early diagnosis and surgery of this condition, with multislice computed tomography being the most accurate method. The aim of this pictorial essay is to the demonstrate the main CT findings associated with Petersen's hernia in patients who underwent Roux-en-Y gastric bypass.

PMID: 20473666 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/20473666


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I hate to say this but if it happened once it can happen again. At least now you know what it feels like.
Two weeks after my surgery I was having terrible pain and my husband called the surg. office and they told him it was normal to have pain after surgery. I was so sick. He started to question if I was being a wimpy. I still have not forgiven him. I had a small bowel hernia that had been slipping back and forth through the muscle wall. By the time I had surgery I lost 6 inches of my small bowel, I am not sure if I was using that part of not, but I am here to talk about it. I had a great surgeon at our local hospital.
So, be careful and I am happy you are here to tell us your story. Your "Lessons Learned" are valuable to us all. Thank you for sharing.

My husband is my rock.  One of my friends had to call him to tell him I was in the ER.  When he arrived at the hospital, his eyes were red from crying.  He was trying to be strong for me, but I could tell he was upset.  He never left my side.

I know it could happen again.   I'm doing everything I can think of to minimize the possibility.  Nothing is going to be binding this gut.  I've purged my closet of every article of clothing that has a zipper or buttons at the waist.  I even bought a pair of "Mom Jeans" yesterday.