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New user query: Post-op distended 'stomach' - why is it so low in my abdomen?

Rank17's picture
Rank17
Posts: 4
Joined: Feb 2014

Hi - Glenn here. I'm new to the site...as a participant at least.

Diagnosed 5 months ago with S3N1 EC...had nine weeks relatively trouble-free chemo, then just under three weeks ago had esophagectomy at Brisbane's (Australia) Mater Private.

Had a few early hiccups (flirted with pneumonia, nasal gastric tube re-inserted) but since then things have mostly gone well. I've been home five days and am eating five or six small meals a day with only modest discomfort - some bloating but now very little reflux. From what i've read here, this seems like a good result.

One thing that's thrown me (I should have asked my doc, I know, but forgot completely) was why, if my new 'stomach' is now sitting in my upper chest, why is it that my wound distension is all in the area of where I perecived my old stomach to sit - in other words, just above my belly button.

This is also the area where i'm tending to get any bloating/build-up of gas, should I end up ingesting anything inappropriate (last night I got caught with this - some toasted pita bread to accompany some mushroom soup....didn't agree with me at all!).

Be interested in your feedback.

 

G

 

 

paul61's picture
paul61
Posts: 1109
Joined: Apr 2010

Glenn,

You did not mention what type of esophagectomy you received but I assume it was a removal of the majority of your esophagus with a “pull up” of the remainder of your resected stomach. I had an “esophagectomy with gastric pull up” using the Ivor Lewis procedure in December of 2009. I have the same basic symptoms that you are describing. When I eat something that does not agree with me or if I eat too much I feel the pressure and feeling of discomfort in the area below my sternum and above my belly button. I had the same thought that you did, “if my stomach is no longer located there why am I feeling the discomfort there?” I asked my surgeon about it once but she didn’t seem concerned about it and had no specific thoughts about why. Over the last four years I have just come to the assumption that it is part of my new normal.

I have some personal thoughts about why that are not based on any particular medical expertise other than experience. What had previously been your stomach has now been formed into a tube to replace your esophagus. Your “stomaphagus” does not really enter into food processing in the way it previously did. It is more of a connection and food storage system that gradually allows food to move through your pyloric valve located at the bottom of your stomaphagus into your small intestine where the majority of your food processing takes place. I think the reason we feel discomfort and bloating in this area when we eat too much or eat something that does not agree with us is a combination of “referred sensations” because the nerves still attached to our stomaphagus still refer sensation to that area and the fact that food tends to collect in the small intestine while being processed.

 I have sort of learned to live with discomfort in the area after eating knowing that it normally passes in an hour or so. If it is gas related I have found OTC’s like “Gas X” that contain symethicone are helpful. I have also found that one of the rules of my new normal is no significant activity for about an hour after I eat. I normally sit down for at least a half hour after eating and it tends to prevent that “over-full and distended” feeling after eating.

 But short of an incisional hernia (where you would have a constant distention and discomfort) I would guess that your experience is normal for someone who has had an esophagectomy with gastric pull up.

 Best Regards,

Paul Adams

McCormick, South Carolina

DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009

Cisplatin, Epirubicin, 5 FU - Four Year Survivor

 

 

Rank17's picture
Rank17
Posts: 4
Joined: Feb 2014

Thanks indeed - that all sounds logical. It's a shame the docs don't make a point of explaining this post-op, as it must cause a fair bit of confusion with other mere mortals.

The "normally sit down for at least half an hour after eating" raises an issue i'm still coming to terms with, as i've had feedback suggesting this, whilst others have indicated they prefer a post-feeding walk.

I've been doing the latter, though I don't so far feel its helping, so I might give your approach a try.

scoot108
Posts: 6
Joined: Aug 2013

Hi,

 

I can give you my guess.  I had transhiatal esopghagectomy September 2012.  It is my understanding something called the vagus nerve was severed as a normal part of the surgery.  This tied brain function with digestive functions.  Now your body is left up to it's own to do things.  I suspect you have a sypmtom of "dumping" syndrome.  Where your food would normally sit in your stomach for a longer period of time and slowly pass on to your intestines the pyloric stomach valve muscle that controlled that now opens to soon and suddenly releases to much, to soon.  The uncomfortable lower feeling is all the food piling in to your intestines.  I to have learned to expect to just feel sick after every meal (some worse than others) but have adjusted to knowing it is usually over in an hour.  I also eat, then just sit still, unbutton my pants and wait for 30-45 minutes until it passes.  Some foods are definetely worse.  I have good luck with turkey and cheese sandwiches, spaghetti and chili.  It seems to just be are new way of life.  I have heard it gets better over time but I think it is more you learn what foods work better and portion sizes better.  Take care.

 

Scott

Rank17's picture
Rank17
Posts: 4
Joined: Feb 2014

Thanks Scott. I actually experienced a classic example of dumping last night. One hassle for me is controlling my type one diabetes. In the past, if my sugars dropped into 'too low' territory I would simply top up with a sugar hit - chocolate or OJ or the like.

This isn't so easy now, as the said 'sugar' hit can act as a trigger for a painful dumping process - cramps followed by open bowels.

That's exactly what I faced yesterday when I resorted to a glass of strawberry milk and a chocolate bar - my blood sugars soon adjusted but then I had to endure three hours of uncomfortable aftermath. 

All this means I'm going to need to be much more careful than pre-op with my insulin dosage.

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