Gall Bladder stones- surgery risks or complications in immunosuppressed

[mannycan]

Hello, My Mother was diagnosed with gall stones a year back; the doctors then said it's just 1-2 stones so nothing to worry about. Recently (4 days back), after have acute pain in the stomach; we took her to hospital where the test results revealed multiple gall bladder stones, which the doctor said, need to removed. She was admitted in the hospital & put on intravenous liquid & antibiotics, to reduce the infection in the gall bladder due to which the wall of gallbladder was thickened. They did some blood tests which disclosed a platelet count of 79000 as against a normal 150000-450000. Her hemoglobin level was also very low (don’t remember the measure). She was released in 2 days, but a nurse came to my home to give her antibiotic injections twice a day for next 2 days. The doctor advised for an open surgery to remove stones & sludge; we got another opinion & found out about other minimal invasive surgery options like laparoscopy (routinely performed by doctors in nearby city with much more advanced medical facilities). One of the doctors we talked to there, (at www.haribhaktihospital.com) said, “sure you can come here, I will do the tests & decide what to do". Present situation: we have traveled to the other city & admitted my mother to the aforementioned hospital; tomorrow the doctor will perform some tests & MRI & advise us on what needs to be done. MEDICAL HISTORY: she’s had multiple Herpes outbreaks in the last 3.5 years, including Zoster & Simplex; all outbreaks have been above the neck. Because of herpes her immune system is very weak & it takes longer for her to recover from any illness. Last year we had to admit her to the hospital for anaemic weakness. Her appetite has decreased & she has lost a lot of weight in last 2-3 years, from about 65 kg to 44 kg. Can you please advise me, how risky is an open surgery or laparoscopy going to be, given her weak immune system & low levels of platelets & hemoglobin?

[mannycan]

Thanks for the reply; Well my mother has already gone through the surgery. The doctor removed the gall bladder using laparoscopy. But he did decide to give her 4 units of platelet blood as she had low platelet count. Her gall bladder was full of stones, couple of them were probably a centimeter in diameter. Phew!

[Kevin Pho, MD]

Difficult to give an accurate opinion without examination.

However, I agree that gallbladder surgery would be helpful in this case if the symptoms continue.  

There is risk to any surgery.  Generally, an open procedure would be more involved and may have a greater complication risk than a laparoscopic procedure.

If there are concurrent medical diseases involving the immune system and possible anemia, a good pre-operative evaluation should be performed prior to surgery.  This should be done by an internal medicine physician who can consult the appropriate specialist as needed.

These options can be discussed with your personal physician.

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.

Kevin, M.D.
www.kevinmd.com

[mannycan]

A little more info: my mother is 57 years old; she has become sensitive to allergies after the herpes (which include itching in body and on face). She also has been experiencing pain in nerve ending in the spots where she got herpes outbreaks.

Because of the weight loss and body weakness she can not do physical movement by herself, like climbing stairs or standing for more than 3-4 minutes at a time or even walking small distances; She has had a lot of mental stress (due to personal reasons) during the last 2 years and she feels depressed wondering why she has become so weak and why she got herpes. Since last 1-1.5 years, she can not sleep properly and wakes up 4-5 times every night to go to the toilet. She only eats 5-6 bites in one go (no where near to what she used to eat 2-3 years back). Although she feels hungry after very short intervals, like every 2 hours or so.

Last year in August, 2006 she was hospitalized, the doctors said her salt and sugar levels had decreased considerably and advised to increase salt in her diet. She was hospitalized for 5 days, where-in everyday the doctors put her on intravenous Dextrose/sodium chloride solution (if I remember correctly) everyday they were giving 3-4 bottles.