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What causes nausea,vomiting and epigastric pain after hiatus hernia repair?

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Posted on Thu, 24 Jul 2014
Question: I had an operation 30 months ago for repair of a giant hiatus hernia and gastric volvulus. After the operation my stomach took a while to get going and I was on TPN for about two weeks. About 12 months ago I started to suffer from intermittent nausea, vomiting, regurgitation and epigastric pain after eating. Last week I had an endoscopy and there was quite a sizeable phytobezoar in my stomach. Does this mean that I have gastroparesis?

Before I had the endoscopy I had an ultrasound scan to see if I had gallstones, but even though I had fasted before the scan my gall bladder could not be found. Would this be connected?

I have had irritable bowel syndrome for about 40 years (I am now 61 years old), but the above symptoms were new. I also have an underactive thyroid, for which I take thyroxine. I had an operation for tongue cancer 7 years ago, but this has not really affected my ability to chew. I have metastatic breast cancer, affecting my bones. Despite all the above I am generally active and feel reasonably well.

Thank you for your help

doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
CT scan

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.

Noted the history of all the problems you have mentioned including the metastatic breast cancer, Hypothyroidism, operated tongue cancer, other surgery for hiatus hernia and gastric volvulus, phytobezoar, no gall bladder seen and all.

For me, if I try to think collectively of all the factors together, my opinion is ::::
The surgery for Hiatus Hernia and Gastric Volvulus is at the hiatus where the main trunks of Vagus Nerve are situated.
Due to the nature of both problems the nerve would already be in a jeopardy, making it more vulnerable during the actual Surgery, or be trapped in the stitches or tackers or later into the inevitable fibrosis.
This occurs as a sort of vagotomy giving rise to gastroparesis and phytobezoar. Added with the already pre-existing conditions you have mentioned.
This might have given you the symptoms you have.

The gall bladder might not have been visualized due to fibrosis and contraction due to disease or due to secondaries in the area of pancreas which in turn can give rise to contraction of gal bladder.

You need to confirm all this by CT scan of the abdomen.

The other diseases have complicated the problem you have.
How big is the phytobezoar, does it need removal? Or removed? This has to be removed as it may act as an obstruction enhancing the present problems.

I hope this information helps to resolve many issues and a chance to have the problems solved. Feel free to ask for more information and a chance for me to serve you more.



Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 19192 Questions

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What causes nausea,vomiting and epigastric pain after hiatus hernia repair?

Brief Answer: CT scan Detailed Answer: Hi. Thanks for your query and an elucidate history. Noted the history of all the problems you have mentioned including the metastatic breast cancer, Hypothyroidism, operated tongue cancer, other surgery for hiatus hernia and gastric volvulus, phytobezoar, no gall bladder seen and all. For me, if I try to think collectively of all the factors together, my opinion is :::: The surgery for Hiatus Hernia and Gastric Volvulus is at the hiatus where the main trunks of Vagus Nerve are situated. Due to the nature of both problems the nerve would already be in a jeopardy, making it more vulnerable during the actual Surgery, or be trapped in the stitches or tackers or later into the inevitable fibrosis. This occurs as a sort of vagotomy giving rise to gastroparesis and phytobezoar. Added with the already pre-existing conditions you have mentioned. This might have given you the symptoms you have. The gall bladder might not have been visualized due to fibrosis and contraction due to disease or due to secondaries in the area of pancreas which in turn can give rise to contraction of gal bladder. You need to confirm all this by CT scan of the abdomen. The other diseases have complicated the problem you have. How big is the phytobezoar, does it need removal? Or removed? This has to be removed as it may act as an obstruction enhancing the present problems. I hope this information helps to resolve many issues and a chance to have the problems solved. Feel free to ask for more information and a chance for me to serve you more.