Problems after 6 years of Nissen Fundoplications

[Maltaguy]

I did an open surgery Nissen around 6 years ago and never had a problem. Only beginning of this year was having some few problems with reflux and as well pain under my ribs when I bend or laugh.

I did a gastroscopy last April and they found only a small hiatus hernia and a small polyp at the duodenal valve but surgeon told me all was ok.

2 weeks ago I went back to hospital since had the same pain under my ribs and the doctor noticed that I was a bit pale in colour so he took some blood samples which resulted in hgb count of 6 so I was immediately hospitalised.

During my stay in hospital they did:

Chest X Ray- Resulted ok
Ultrasound of my abdomen - Resulted ok
Barium Enema - Resulted ok

Finally they did a Barium meal and the doctor noticed that 1/3rd of my stomach was herniated (large hernia). He told me that it passed the diaphram and was behind the heart. I notice sometimes lack of breath and small pain in my chest.

My surgeon (same one that did me the Nissen) put me on losec back again and shall do me an endoscopy next Monday and afterwards a capsule endoscopy.

Upto now they dont know if the blood I lost was coming from the hernia. Sometimes though very rare (maybe once on 3months) my stools where dark brown almost black.

I am 42 years of age and male. My apetite is normal even if I have to eat a little bit and very frequently since I feel my stomach filled up. Losec doesnt seem to be working like in the past. Do you reckon I will need another Nissen ?
Moreover do you think I should speak to a cardiologist ? I used to smoke a packet of cigarettes a day now I stopped 2 weeks ago.

Thanks for any info you might give since my surgeon presently seems confused on what I might have and from somewhere I am loosing blood.

[Enoch Choi, MD]

Congrats on stopping smoking 2 weeks ago, keep it up, that will help a ton!

So sorry to hear of your serious medical issues at such a relatively young age.  The anemia (low red blood cell count) is concerning and the source of bleeding must be found, which should be apparent soon from the EGD esophageal-gastro-duodenoscopy (fiberoptic scope).  A common place to bleed from is from a stomach ulcer, and herniation of the stomach into the chest cavity can increase the irritation of the top part that slips up into the chest.  That part, the antrum, is where acid is produced in the stomach.  Acid reducers such as proton pump inhibitors and antacids can help.  A cardiologist can't help find out where bleeding is from.  If the EGD is unrevealing, colonoscopy is reasonable to consider.

[Maltaguy]

Thanks for the concern.

I did the gastroscopy last Monday as scheduled. Unfortunately they had to keep me in hospital for 24 hour observation since during the procedure I encountered some problems with my respiration under anaestisia.

As regards the gastroscopy my surgeon told me they found severe duodenitis and he is thinking that most probably I lost blood due to this very severe duodenitis. CLO test was negative. He put me on another type of medicine and removed me the Losec. Strangely enough he mentioned though nothing about the hernia and he said that there is no need for an operation and if I continue to see blood in my stools they will do a capsule endoscopy.

Today am going to a cardiac/lung surgeon since I am having some sort of problems with either my circulation or respiratory system.

Am still confused if I have to either change surgeon and take a second opinion as regards my stomach problems (hernia) or else stress my surgeon to try another Nissen since I think that if I have a hernia that is one third of my stomach this can create problems in my duodenum or other parts of my gastro system and medication never helped in my case.