I first met Ms. Vega on April 5, 2017. The most important thought in my mind at that time was getting her in the operating room as soon as possible. The results of the imaging tests done on arrival to the Emergency Room were definite and critical. They indicated the presence of bowel ischemia, which meant that at least some of her small intestine was lacking blood supply due to an internal hernia, which is a potential complication of gastric bypass surgery. For this condition, time was crucial and this was a life –threatening situation. She had a gastric bypass at an outside facility over 3 years prior, and although she experienced frequent episodes of abdominal pain, the cause had not been determined.
I explained her condition to Ms. Vega, listed a laundry list of risks and tried to convey the gravity of her condition, but her eyes told me she knew all too well that her condition was critical. Her words still make my body tense up. She said “I have 3 kids, I need to get back home to them, do whatever you need to do”. Unfortunately, this led to over two months in the hospital, malnourishment, fatigue and a drastic change to her life. And yet, we are truly blessed, for she is at home with her kids, she is slowly regaining her energy, and her wounds have completely healed.
I explained her condition to Ms. Vega, listed a laundry list of risks and tried to convey the gravity of her condition, but her eyes told me she knew all too well that her condition was critical.
Through all of this, Ms. Vega never lost her resilience and her strength. We both want to share her experience to raise awareness about the long-term complications of bariatric or weight loss surgery. This is a topic that many people may not be familiar with. Each day, more patients are benefiting from weight loss surgery. However, there may be subtle symptoms that should not be ignored. Some of these long-term complications include ulcers, nutritional and vitamin deficiencies, and internal hernias or bowel obstruction. Ulcers are rare and occur in 1% of patients, internal hernias may occur in approximately 5%, yet nutritional deficiencies may be a prevalent as 80%.
For patients who have undergone gastric bypass or sleeve gastrectomy, I strongly recommend regular yearly follow up with their surgeon. At the very least, yearly follow up of labs and vitamin levels should be done. Importantly, if anyone with a history of a gastric bypass surgery is experiencing pain shortly after meals, he or she should discuss any associated symptoms or patterns of this to rule out an internal hernia.
Today, Ms. Vega continues to be compliant with her vitamins, fluids, and protein intake. Despite what she went through, she does not regret having had a gastric bypass as this improved her quality of life and her health.
By Veronica T. Guerrero, MD