Bariatric surgery complications: Difference between revisions
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Revision as of 01:37, 11 September 2015
Background
- Rou-en-Y - malabsorptive and restrictive physiology
- Gastric Sleeve - restrictive
- Biliopancreatic diversion
- Vertical banded gastroplaty - now historical as replaced by LAP band
- Lap Band Complications
Clinical Features
- abdominal pain, food intolerance
- sepsis, abnormal VS
Differential Diagnosis
Early
- VTE, PNA, UTI, SBO, etc
- Roux-Limb Obstruction
- NV, abd pain
- causes acute Gastric dilation
- surgical emergency
- IR decompression possible
- Anastamotic Leak
- abdominal exam often non-acute due to habitus
- Intra-abdominal bleeding
- may bleed into GI tract and only visualized on endoscopy
Late
- UGIB
- resuscitate in stanrd fashion
- emergent endoscopy
- often bleed from staple lines, ulcers
- Anastomotic Leak or Stricture
- progressive inability to tolerate PO
- abdominal pain
- solids first then liquids
- needs UGI then likely endoscopy
- Marginal Ulcer
- epigastric pain and dyspepsia
- upper endoscopy
- manage with acid suppression
- Internal hernia
- obstructive or nonobstructive
- crampy intermitten abd pain radiating to back
- can have nl abd exam
- may strangulate herniated bowel
- w/u CT AP and UGI
- CT findings swirl sign, intussuscepted bowel
- needs surgery early
- Nurtitional Complications
- consider pts immunosuppressed due to malnourishment
- Anemia, neuropathy, fractures, hypercalcemia
- Wernickes encephalopathy
- Dumping syndrome
Diagnosis
- CT AP - use PO & IV contrast
- pts often cannot tolerated full 1L of PO contrast
- sip as much contrast as possible in 3hrs then CT
- weight limit of CT scanner often exceeded
- can use Gastrograffin UGI series instead
- UGI series
- beware GI pouch limits on contrast volume
- usefull for perforation, internal hernia, stricture, leak
See Also
Source
Ann Emerg Med. 2006;47:160-166., Tintinalli