I had Roux-en-Y gastric bypass in October 2008, and I haven’t really followed my doctors advice in the last year or so. My question is, 1 yr ago I had pain my chest so I got scheduled for an endoscopy and as it turned out no blockages, but it did show I have acid reflux.
I have since gone for another endoscopy and one of the Y branches has a blockage. The doctor doesn’t know how far but he said he could only get the scope in 30cm. He doesn’t know why or how far this blockage goes, and has scheduled me for a CAT scan to see how far this blockage goes and if it has to be fixed or reversed.
At this point I am unknowing, confused and scared. There has been a lot of nausea, vomiting, and a lot of stool backing up which is quite painful so I am on a regimen of 2 docusate, and 2 senecot every morning and every night – but at this point the not knowing is really scary, can you help me?
Surgeon response to "Roux-en-Y Gastric Bypass Blockage"
by: John Rabkin, M.D., Pacific Laparoscopy
Sherri,
It isn't at all clear to me that you have a blockage of your reconstructed intestinal anatomy.
When a Roux-en-Y Gastric Bypass (RNY) is performed, generally there is a short 'blind limb' which is created so that if your gastroenterologist who did your more recent endoscopy was trying to pass the endoscope down that side of your gastroenterostomy (stomach to intestine connection) it would be 'blocked' by design.
However, if your endoscopist is describing that the "blockage" is at the "Y" junction of your jejunojejunostomy (intestine to intestine connection where the roux-en-Y limb is created) then perhaps there is a narrowing or blockage of some sort. This could certainly account for the nausea and vomiting which you have been experiencing.
As you are already scheduled to have a CT scan of the abdomen, I would await the results of that test which may shed some light on what/where the problem may be. If that isn't conclusive, an upper gastrointestinal series with a small bowel follow-through (UGI) would be the next examination to undergo.
Ultimately, you may need a diagnostic laparoscopy/laparotomy and, if a problem is identified, a revision or reduction of an internal hernia which I would expect would be the most likely explanation for your symptoms.
Most importantly, as you indicated that you "hadn't been following your doctor's advice" this past year, you should make certain to do so and to re-establish care with your bariatric surgeon at this time if you haven't already done so.
Once you are under the care of your bariatric surgeon who will 'steer' you through these difficulties, I wouldn't worry about your recovery back to a healthy post bariatric surgery condition. He/she will get to the root of the problem and arrive at a solution for you, even if it requires surgical repair.
John Rabkin, M.D.
Pacific Laparoscopy
(click here for Dr. Rabkin's full bio & contact info)
DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.
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