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A few weeks ago I was taken by ambulance to the hospital for severe stomach pain.  Symptoms were severe bloating, pain while walking unless medicated on pain meds, unable to hold urine normally and peeing myself while I sleep or sneeze.  

After tests showed a stomach full of fluid, the ER doctor admitted me for the weekend for further tests.  Dr Fleshner, my new gastro, had already determined there was fluid filling my stomach after a CAT scan for my frequent blockages.  After another test, he told me he didn't see a problem and to carry on as usual.

I ended up having a paracentesis in which 1150ml of fluid was taken from my stomach.  I believe that's almost like 2lbs of water!  Not only did I feel immediate relief, but my stomach was no longer bloated and the flattest it has been since my reverse ileostomy in February (I had a j pouch revision for prolapse repair last October).  There was no more bulge and the pouch was working beautifully.  I was finally emptying!  I also had no more pain in stomach or bladder and was beginning the process of laddering down off pain meds.

Unfortunately, I had a set back a few days ago. Another blockage and an appt with Dr Fleshner yesterday confirmed fluid filling back up again.  He said diuretics were pointless and suggested an exploratory laparotomy and lysys of adhesions.

My question is, has anyone had this done?  What is the success rate?  Dr Fleshner does not have the most patient bedside manner.  He might be the best surgeon in the world but it is a bit challenging to get answers from him.  
I feel like I should get another scan to determine if it is actually water or just gas from blockages.  He nixed that idea.  Would you get a second opinion?  How often are these surgeries performed?  If you had one, did you find immediate relief?  Did it stop the fluid?  He wants to put some sort of implant in my stomach to prevent scar tissue from building up.

FYI, the hospital found all organ functions to be normal.  Also, the paracentesis hurt like a !!!  At first, he was against the idea of me getting drained and expressed surprise that they did it because of the risk of infection and it being pointless since I would probably fill back up.  However, he changed his mind because of the remarkable difference in how the pouch performed. 

Am I in good hands??? Also, is living with 1150ml of water really supposed to be manageable?!  I felt like I had a beachball in my stomach. I was in such bad shape that I had seriously considered ending my life.  After draining me, I did a 180 and felt positive, full of hope, and optimistic about the future.  Needless to say, I am pretty bummed about another surgery but it if means getting back to where I was before this last blockage, I am just about willing to do anything!

If this is Dr. Phillip Fleshner then I believe that he's a colo-rectal surgeon rather than a gastroenterologist. It's possible that a gastroenterologist might be trying to figure this out non-surgically. That doesn't necessarily mean that it would be figured out that way, though. In any case, it's quite important for the cause of the ascites to get figured out.

Dr. Fleshner is really proposing two procedures in one: the exploratory laparotomy is intended, I'm guessing, to try to find out why the ascites developed. It might be helpful if you could get him to offer a list of possibilities, so you know the sort of things he'd be looking for. If he finds and fixes the problem then you'll be better, but it's impossible to know if he'll succeed at that.

The lysis of adhesions is certainly appropriate if you need to be opened up for other reasons. One or more of those adhesions are very likely the cause of your obstructions, and cutting the adhesions will stop those particular ones from further troubling you. The risk is that, even if they find and cut the most troublesome adhesions, new ones may form after the surgery and cause new problems. The "implant" may not completely prevent the formation of new adhesions, but it may help reduce them.

I guess if it were me I'd want to chat with a good gastroenterologist first, even if I thought it likely that I'd have to ultimately let the surgeon poke around. I'd want the surgeon to have the best possible idea of what to look for and where to look for it. If you don't currently have a gastroenterologist, though, it can take a fair amount of time to get a first appointment.

Scott F

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