Bariatric surgery complications: Difference between revisions
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*[[Lap Band Complications]] | *[[Lap Band Complications]] | ||
== | ==Clinical Features== | ||
*abdominal pain, food intolerance | |||
*sepsis, abnormal VS | |||
==Differential Diagnosis== | |||
== | |||
===Early=== | ===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=== | ===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== | ==See Also== | ||
[[Lap Band Complications]] | *[[Lap Band Complications]] | ||
==Source== | ==Source== | ||
Revision as of 12:28, 12 May 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