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Re: Post Nissen fundoplication Pain-rapid dumping
Posted By HFHSM.D.-rf on May 21, 1998 at 10:43:57:

In Reply to: Post Nissen fundoplication  Pain-rapid dumping posted by Patty on May 17, 1998 at 12:35:31:

Greetings, I am a 42y/female who underwent Nissen
fundoplication for severe reflux disease.Surgery was
in December 97. Since surgery I have experienced daily
bouts of diarrhea. These are no normal movements. They
usually begin with gurgling sounds, rapid heart beat,
feeling like I am going to pass out, this is usually
followed by explosive bowel movements, which at times
shorly after surgery, I was unable to make it to the
bathroom. The bowel movement is usually watery, with
no formed stool. I have mentioned this on several
ocassions to my surg, he mentioned that there might
have been some vagal nerve injury due to the surgery
and the very large H. Hernia , which caused a huge
repair and contact w/ said nerve. What is know about
this???? I have lost 50 pounds since surgery and I am
afraid to really eat very much, as it will cause this
problem. Do you have any advice ? I have sought the
assistnce of a GI , had all studies, etc. upper GI,
colonscopy ( which showed some inflamation and polyps)
also due to this excessive BM, I also had a hemmorriod
surgery, due to internal hemm. HELP  !!!! Thanks for
any assistance. Looking forward to your response.

Dear Patty,
Based on the response to your e-mail, I realize that your problem is more common than I wouild have guessed from the medical literature describing the complications of fundoplication.  Vagal injury can occur during a fundoplication as was written to Skorchee.  The frequency of this complication is uncertain.  While your surgeon is correct that vagal injury may cause diarrhea, other more likely causes must be considered. Could this problem be related to the medications that you are taking? You may want to stop all unnecessary medications and observe if the diarrhea resolves.  Under physician guidance you may even need to stop all medications.
Your letter indicates that a number of tests have been performed.  Was a small intestine biopsy done?  This test is needed to rule out malabsorption.  If all the other endoscopic tests are negative and you do not have any intestinal infections, then it will be necessary to search for the coincident development of other illnesses.  Your physician will need to determine if your diarrhea is due to what we refer to as osmotic or secretory causes and then initiate the indicated workup to identify the specific cause.  

This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and initiate treatment to improve your symptoms.  You can arrange an appointment with Dr. Fogel, one of our experts in the investigation of diarrhea.  He can be reached by calling the Henry Ford Physician Referral Line at (800)653-6568.
*keywords: fundoplication, diarrhea, weight loss, malabsorption

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