Talk to General Surgeon on Gastrojejunostomy Decision
Asking For Someone else, Father, Male, 67 Years old, karachi
My father’s latest endoscopy has revealed a blocking in his stomach that causes him to vomit out food . The biopsies taken donot show any malignancy. Tha doctors are still adamant that the stomach doesnt seem normal and a deeper biopsy should be taken, along this the procedure also includes attaching a part of small intestine to the stomach providing a path for food. The issue lies in decision that the patient also has dvt; if the blood clot remains as it is, the surger is categorized high risk due to PE risks. If blood thinners are given, increased blood loss during surgery is also a risk. Is there any way the clot dissolves and the blood is again thickened to avoid any risks imposed bu dvt?… till then should the nutrition be given by iv or is Nj tube a better option? Or is there any way the surgery is proceeded with the clot stopping its flow through several veins and its reach in heart or lungs? Is IVc filter placement logical in this case?
Asst. Prof. Dr. Junaid Zaman - General Surgeon
MBBS, FCPS (Surgery), MRCS (Ed) | Karachi
my sympathies with you but unfortunately there is no right and wrong answer. now gastrojejunostomy is an undertaking and yes there will be chances of bleeding. I do believe you have to weight the risks and go with surgery
Asst. Prof. Dr. Afzaal Aftab Khan - General Surgeon
MBBS, FCPS (General Surgery), ATLS | Lahore
10 Positive Reviews
Yes, pt has to undergo some intervention by hook or crook, first diagnosis needs to be built, if it turns out to be malignant then no rationale of gastrojej, as it will be occluded soon, if not then it can be an option, regarding fitness and risk other options should also be considered, you can visit for further discussion
what does CT abdomen say? the malignancy could be behind the stomach e.g lymphoma.
Yes, he needs IVC filters. then transfuse fresh frozen plasma and proceed with surgery.
There is minimal risk of bleeding in a gastrojejunostomy if proper stapled anastomosis is made
DVT can be treated first. Blood thinners are then stopped temporarily and surgery can be performed.
Dr. Fahreyar Alam - General Surgeon
MBBS, MSc (CF), MRCS (Glasg), MRCS (Eng), FRCS (Gen Surg) | Lahore
19 Positive Reviews
- NJ feeding better
- IVC filter placement pre operatively
- Definitive histological diagnosis is essential prior to surgery as curative cancer surgery will differ from just a gastro jejunostomy to by pass gastric outlet obstruction secondary to a benign pathology
- NJ feeding will be the preferred route till then to mantain mucosal barrier, gut health and avoid complications of TPN.
Hope it makes sense
Prof. Dr. Khalid Ibrahim Akhtar - General Surgeon
MBBS, FCPS Surgery, FRCS (Glasg), MRCS (Glasg) | Rawalpindi
5 Positive Reviews
surgery can be done we will switch from oral blood thinners to inj clexane which can be stopped temporarily before surgery then restarted
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