As you probably know, there are many causes of sudden attacks of abdominal pain. The attacks may or may not be related to your previous weight loss surgery. The very best thing for you to do is consult with your primary care physician. If she or he isn't sure, ask for a referral to your bariatric surgeon or to a general surgeon in your community. If getting a referral is an issue because of managed care, make the appointment with your bariatric surgeon on your own.
To do a proper diagnostic work up, your surgeon will need to take a complete history, do a physical exam, and may need to do additional diagnostic testing.
Also please discuss the use of a NSAID pain medication with your physician. After gastric bypass, drugs like Ibuprofen may lead to ulcers of the jejunum near the gastrojejunal anastomosis (connection). Some bariatric surgeons feel that NSAIDS should virtually never be used. Others recommend that a patient be on an acid blocker when NSAIDS are used. As a general rule, use the smallest dose of NSAIDs for the shortest possible length of time.
One cause of intermittent abdominal pain after weight loss surgery is biliary colic. Gallstones may form in the gallbladder and may escape into the common bile duct. Gall stones are diagnosed by history, physical exam, and a combination of liver function blood tests, ultrasound, HIDA scan, MRCP, and ERCP.
Another cause of intermittent acute abdominal pain after any abdominal surgery including gastric bypass, duodenal switch, or adjustable gastric band surgery is small bowel obstruction. The bowel can loop over an adhesion or can duck under another loop of bowel. Sometimes the small bowel can telescope into and out of it itself, a process is called intussusception. Sometimes there may be a relatively narrow area in the bowel. Some types of food may stick in the narrowing for a while. Finally, adjustable gastric band tubing has been associated with small bowel obstruction.
Intermittent bowel obstruction can be very difficult to diagnose. Diagnostic studies such as CAT scan or upper GI series x-rays may be normal between attacks. Sometimes surgical exploration by laparoscopic or open technique is necessary to rule out problem areas that can cause obstruction.
There are a number of articles in the medical literature on this subject. You can find summaries of the articles through the US National Library of Medicine. Google PubMed. Remember, these are only abstracts and one really has to read the entire article to get all the information. Also different authors have different points of view, so no one article will tell the whole story.
Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.
Husain S, Ahmed AR, Johnson J, Boss T, O'Malley W.
Department of Bariatric Surgery, University of Rochester, Highland Hospital, 1000 South Ave, Rochester, NY 14620, USA.
OBJECTIVE: To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass. DESIGN: Retrospective record review. SETTING: University-affiliated hospital. PATIENTS: One hundred five consecutive patients undergoing surgery for intestinal obstruction after laparoscopic Roux-en-Y gastric bypass between May 24, 2001, and December 1, 2006. MAIN OUTCOME MEASURES: Common presenting symptoms, causes, yield of radiological studies, and types of surgical procedures performed for post-gastric bypass bowel obstruction. RESULTS: A total of 2325 laparoscopic Roux-en-Y gastric bypass procedures were performed during the study period. A total of 105 patients underwent 111 procedures. Bowel obstruction was confirmed in 102 patients, yielding an overall incidence of 4.4%. The most common presenting symptom was abdominal pain (82.0%), followed by nausea (48.6%) and vomiting (46.8%). Thirty-one patients (27.9%) presented with all of the 3 mentioned symptoms. The mean time to presentation was 313 days after bypass (range, 3-1215 days). Among the studies, results in 48.0% of computed tomographic scans, 55.4% of upper gastrointestinal studies, and 34.8% of plain abdominal radiography studies were positive for intestinal obstruction. In 15 patients (13.5%), all of the radiological study results were negative. The most common causes were internal hernias (53.9%), Roux compression due to mesocolon scarring (20.5%), and adhesions (13.7%). Laparoscopic explorations were carried out in 92 cases (82.9%). The incidences of bowel obstructions were 4.8% with retrocolic Roux placement and 1.8% with antecolic Roux placement. CONCLUSIONS: Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.
Arch Surg. 2007 Oct;142(10):988-93.
An unusual complication of gastric banding: recurrent small bowel obstruction caused by the connecting tube.
Zappa MA, Lattuada E, Mozzi E, Francese M, Antonini I, Radaelli S, Roviaro G.
Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, and Universita' degli Studi di Milano, Italy.
marcoantoniozappa@libero.it
Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for morbid obesity. The application of this mini-invasive approach has given the benefits of shorter hospital stay, less postoperative pain and quicker functional recovery. LAGB complications are related either to the access-port, such as port-site infection or tubing disconnection, or to the band, such as band slippage, pouch dilatation, or intragastric migration. We report a case of recurrent small bowel obstruction caused by the connecting tube around a jejunal loop, in a woman who had under-gone LAGB 3 years before. The diagnosis was difficult to establish because the clinical history and examination were non-specific. A 3-dimensional CT scan was needed to explain the cause of the recurrent abdominal pain, and the small bowel loop was freed from the connecting tube at laparoscopy.
Obes Surg. 2006 Jul;16(7):939-41.
Intermittent abdominal pain 3 years after WLS
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