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Wednesday, April 06, 2005

Ask Kaye: Is it possible I've blocked my stomach?

Is it possible to block the outlet from the stomach pouch to the intestine?

In a gastric bypass the connection between he stomach pouch and the small intestine is called the gastrojejunal anastomosis. It is roughly the diameter of a ladies little finger. This small opening slows food from leaving the stomach too quickly prolonging the satiated feeling. In extremely rare cases scar tissue may form at this connection resulting in a blocked outlet. Treatment to correct this is the insertion, endoscopically, of a special balloon. The balloon is inflated and expands the anastomosis returning it to the correct size.

If you have symptoms of blockage that is not the result of overfilling the stomach pouch seek the advice of your bariatric professional. The symptoms include chronic vomiting and food intolerance.

More commonly, a blockage of the anastomosis is caused by poorly chewed foods. Patients must be diligent in avoiding foods that may cause a blockage. This includes large pills, some types or too much bread, overcooked or chewy meats, starches and nuts. If a pill becomes lodged in the stomach outlet it will usually dissolve after a few hours. If food becomes impacted it will be painful. Food will eventually digest and dislodge itself in most cases. In extreme cases a patient may need to have an endoscopy to dislodge the offending food. Patients in the habit of chewing their food will rarely encounter a blockage or plugged outlet.

I caused a blockage with honey-roasted peanuts when I was six months post-op. It was the most painful experience in my bariatric life. And it happened before I realized the damage I was causing! While grocery shopping I purchased a 16-ounce can of honey-roasted peanuts, supposedly for my husband. Feeling particularly chipper, I put some great tunes on the stereo, opened the nuts and set them beside me and happily drove the 30 minutes home. All the way I ate peanuts. Recklessly. Mindlessly. I ate just like I used to when I was obese, throwing another handful in my mouth before I’d finished the mouthful I was working on. Apparently it slipped my mind that I was a new person with improved eating habits and system to keep me honest. Literally sixteen ounces of peanuts were packed into my tinny tummy in 30 minutes.

I had enough time to put away the groceries before the pain began. For three days I was curled in the fetal position with a painful tight pressure in my chest. Keep in mind that the tiny tummy after bariatric surgery is high in the chest, right behind the sternum, not in the abdomen where we usually think it is. On the third day of suffering I called my surgeon and told him I had broken my pouch. He kindly recommended a dose of Pepto Bismol and that provided immediate relief. My tiny tummy was sore for another week and my food tolerance was very low for ten days. Fortunately I didn’t sustain permanent damage to my tiny tummy.

Why did I wait so long before calling the doctor? Simple answer. I was ashamed and embarrassed. I felt I had let my surgeon – my healer - down by doing something so contrary to the rules he had given me to optimize my new system. I didn’t want to admit to him that I had lost control. Second, why didn’t my body warn me of the violation sooner? My body did warn me, but I ignored the feeling of fullness. By the time I acknowledged my body’s satiated feeling it was too late: my stomach pouch was impacted.

To this day when I mention “the peanut episode” my husband and I bow our heads in silent remembrance of this most painful event. I could have avoided this incident if I had respected my body and honored the bariatric rules. I was snacking. I wasn’t chewing my food. I ate too much. Since “the peanut episode” I have enjoyed nuts occasionally. I measure a scant one-tablespoon and include them with a meal. I chew thoroughly before swallowing. I no longer aimlessly eat in my car. Never. From this episode I learned the courtesy: I will respect my tiny tummy by not eating mindlessly.

Please respect your tiny tummy and honor the rules. It is entirely within your control to avoid this type of incident. If you do have a lapse of judgment and cause a pouch blockage give it a few hours and a dose of Pepto-Bismol to provide relief. If that doesn’t work then call your surgeon or primary care physician and follow their instructions.

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