Doctor is stumped

Question

Last June my mother had a total gastrectomy for stage IV gastric cancer.  For about 2 weeks, she was able to eat food in addition to feeding tube feedings.  After that, she began vomiting anything she ingested.  She completed 6 weeks of radiation (including 6 days of chemotherapy) about 2 months ago and testing has showed no cancer remaining, although she has a "bump" on her lumbar spine which will be biopsied (the doctor thinks it may only be related to arthritis).  THE DOCTOR HAS NO IDEA WHY SHE CANNOT EVEN KEEP A SIP OF WATER DOWN.  He thinks maybe some of her intestines are pushing food in one direction, while other parts are pushing food in a different direction.  The reason this makes no sense to me is because she recently had her esophagus stretched and was able to eat for about 1-1/2 days afterward.  The person who did the procedure said the balloon went right down, but he could see her esophagus close up again.  (she had her esophagus stretched once before with the same result).  A barium swallow (actually, it was put into her feeding tube), performed the next day, showed no blockage.  Later in the day after the barium test, she was sick and no longer able to eat or drink without throwing up.  Has anyone, anywhere, ever heard of something like this happening or, better yet, does anyone know how such a thing may be treated?  The doctor wants to do exploratory surgery and perhaps "reconnect" her.  I don't know how she would survive it -- she is dehydrated and wasting away before our very eyes.  
A couple of other issues... 1) almost 6 months after surgery, shouldn't she be getting vitamin B12 shots?   2) her feeding tube keeps leaking a yellow liquid.  What is that and how can it be stopped?  Her doctor doesn't seem to address it.  The tube had actually come out a couple times and had to be sewn back in.  She gets so sick when she is fed, that she is hardly getting 500 calories a day.

She lives near Pittsburgh, PA and is supposedly seeing the top doctor there, but we are losing faith quickly.  Referrals, recommendation, suggestions... anything would be appreciated before she winds up in surgery again.

Kevin Pho MD · Answer

Surgeon has kindly addressed your issue in his comments below and I agree with his assessment.

Regarding the B12 shots.  They are not absolutely necessary after surgery.  I would suggest obtaining a B12 level to determine the need for supplemental therapy.

As for the yellow liquid leaking from the tube.  It is hard to say without seeing it.  It may be the regurgitation of the liquid tube feeds.  As surgeon mentions in his comments, the presence of radiation makes a clear diagnosis difficult.  I would probably suggest a GI referral to evaluate if are any motility issues that can be addressed. 

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case. 

Thanks, 
Kevin, M.D.

surgeon · Answer

It's very hard to say what's going on, especially without knowing the exact anatomy of the method of reconnection of intestine to esophagus. Having had radiation to the field complicates the picture further, both in terms of pinpointing what might be wrong, and in terms of repairing it. The feeding tube is presumably "south" of the connections, and therefore an xray thru it doesn't show the anatomy of her hookups. For now, it seems achieving adequate nutrition must be the goal; function might improve on its own with time, if she were adequately nourished. I'd be thinking in terms of TPN (total parenteral nutrition, meaning a special IV for high calorie intravenous feedings, which can be arranged to continue at a home setting) and possibly at some point re-doing the feeding tube which is a fairly small operation that can be done out of the surgical field, probably.

LAT · Answer

Thank you very much for taking the time to read my question and to comment on it.  I don't know if this additional information may help or not, but I know that when the "reconnected" her, they made a very small pouch out of her intestines.  She is connected just below her sternum.  

The problem with being unable to keep anything down began long before the radiation.

The feeding tube goes into her lower left side.  It is definitely well below where they connected her intestines to her esophagus.

tessa0825 · Answer

Hello, I wanted to tell you that from Pittsburg, you are only about 2.5 hrs. (driving time) about 135 miles, away from the Cleveland Clinic..They are ranked very high for gastroenterology disorders, they also have the Tussig cancer center that is very good.....I have received excellent care from their gastro Dept. and also from their thoracic surgery dept...I hope your Mom gets feeling better...

Doctor is stumped

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