Post-Surgery Concerns: Managing Vomiting After Gastric Perforation

Case 166293 Follow-up Inquiry - Subsequent Issues After Treatment for Perforated Stomach Leading to Peritonitis

Dear Dr.
Chen,
Thank you for your response.
Currently, my family member is still fasting and has not consumed any water or food.
They are receiving nutritional injections, fats, and saline to maintain their nutritional status.
I would like to correct the total number of days in the hospital, which is 72 days (I previously mentioned 45 days).
Additionally, I would like to note that after examinations, there was a deficiency in electrolytes, and they have started to receive electrolyte supplementation.
At present, due to vomiting and the administration of sedative medications, their mental state is quite poor, and they are unable to get out of bed to exercise.
However, my family member is making a great effort; as long as their physical condition allows, they walk 2 to 3 times a day for about 10 to 20 minutes.
Before the onset of vomiting, they were in better spirits and would exercise regularly.
Since you mentioned that there may be some issues with abdominal adhesions, I would like to ask whether the current vomiting is severe enough to warrant further evaluation for additional tests or surgery due to adhesion problems.
Are there other methods for improvement? Is there truly no underlying health issue? My family member's gastric perforation led to peritonitis, which was an acute situation.
They were previously very healthy, with good results from health check-ups and no gastrointestinal issues, as well as no bad habits or exposure to highly polluted environments, and they did not experience any discomfort.
However, the onset of peritonitis was sudden, and we still do not know what could have caused such a severe condition.

Seeing that the treatment issues over the past 75 days have gradually improved, it is concerning that this unexplained vomiting has emerged at such a critical time, leading to a significant decline in their mental state.
I am truly at a loss for how to further investigate the cause and treatment options.
I understand that the medical team has been doing their utmost, but I have not been able to obtain clear answers from them.
Therefore, I am seeking online consultation to help me analyze and think objectively about the situation, hoping for a swift resolution to the problem.
Thank you very much for your response, Dr.
Chen.
Sincerely,
Doctor Q&A Teams

Ms. Lu, 20~29 year old female. Ask Date: 2021/03/13

Dr. Chen Jiaming reply Surgery

Currently, the administration of nutritional injections, lipids, and saline solution is only a part of the "maintenance" treatment.
As for investigating the underlying causes, a comprehensive assessment of the clinical condition is necessary.
Although you have made great efforts to reconstruct the entire treatment process and current status, many aspects still require a clinical physician to perform a physical examination, along with blood tests and various imaging studies, to make accurate judgments and provide recommendations.
It is advisable for you to confirm the current treatment plan and goals with the attending physician once again.
Wishing your family a speedy recovery.

Reply Date: 2021/03/13

More Info

Post-surgery concerns, particularly after a serious condition like gastric perforation, can be quite challenging for both patients and their families. Your family member's situation, including prolonged hospitalization and the current symptoms of vomiting and electrolyte imbalance, requires careful management and monitoring.
Firstly, it’s important to understand that vomiting after surgery can be attributed to several factors. In the case of gastric perforation, the body undergoes significant stress, and the surgical intervention can lead to complications such as adhesions (scar tissue that can form between abdominal organs), which may cause blockages in the gastrointestinal tract. These adhesions can lead to nausea and vomiting, especially if they are severe enough to impede the normal passage of food and fluids through the digestive system.

Given that your family member has been on a strict regimen of intravenous nutrition and has not yet resumed oral intake, the vomiting could also be a response to the body adjusting to the absence of food. The use of sedative medications can further complicate this, as they may affect gastrointestinal motility and contribute to feelings of nausea.
In terms of management, it is crucial to maintain close communication with the healthcare team. If the vomiting persists, it may warrant further investigation. This could include imaging studies, such as an abdominal ultrasound or CT scan, to assess for any signs of obstruction or complications related to adhesions. Additionally, the healthcare team may consider adjusting medications to alleviate nausea and improve overall comfort.

Electrolyte imbalances are common in patients who have been on prolonged intravenous nutrition. It is good to hear that your family member is receiving electrolyte supplementation. Monitoring these levels is essential, as imbalances can lead to further complications, including muscle weakness, cardiac issues, and neurological symptoms.
Encouraging gentle movement, as your family member has been doing, is beneficial. It can help stimulate bowel function and may reduce the risk of further complications from immobility. However, it is essential that any physical activity is approved by the medical team to ensure safety.

As for the underlying cause of the initial gastric perforation and subsequent peritonitis, it is often difficult to pinpoint a specific reason, especially in previously healthy individuals. Factors such as stress, medication side effects, or even undiagnosed conditions can contribute to such acute events. Continuous follow-up and monitoring are vital to ensure that any emerging issues are addressed promptly.

In conclusion, while the current vomiting and discomfort are understandably concerning, they can often be managed with appropriate medical intervention. It is crucial to maintain open lines of communication with the healthcare providers, advocate for thorough evaluations if symptoms persist, and ensure that your family member receives the necessary support during this recovery phase. Your proactive approach in seeking information and understanding the situation is commendable and will aid in navigating this challenging time.

Similar Q&A

Post-Surgery Concerns After Gastric Perforation: Your Questions Answered

Hello Dr. Hong, I would like to consult you on the following issues. Thank you. Summary of the condition: I maintain a normal lifestyle, do not smoke or drink, and do not stay up late. However, recently I took medication for two weeks due to sinusitis (the doctor did not prescri...

Dr. Hong Yuanbin reply Internal Medicine
Hello, 1. Due to endocrine factors, along with the fact that it is quieter at night, most pain tends to be more pronounced during the night; this is a physiological phenomenon. If there is a sudden severe pain, then it is necessary to seek medical attention. 2. Yes, surgery c...

Post-Surgery Complications After Gastric Perforation and Peritonitis Treatment

Dear Dr. Chen, I hope this message finds you well. I would like to provide a detailed account of my family member's clinical course due to a gastric perforation leading to peritonitis, in hopes of receiving a comprehensive response. My family member, a 57-year-old female, u...

Dr. Chen Jiaming reply Surgery
It has been tough for your family to experience such a condition. Since the attending physician has already discussed the situation with other specialists, they have likely considered various common causes of vomiting without arriving at a more refined opinion. I can only offer m...

Post-Surgery Care Tips for Faster Recovery After Abdominal Surgery

Hello Doctor: I have a classmate who was hospitalized at the end of July due to abdominal pain. The doctors initially suspected appendicitis, but after surgery, they discovered it was not the case. Due to the delay in seeking medical attention and the long waiting time, he suffer...

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, there are three main causes of intestinal perforation in young individuals: 1. Appendicitis leading to perforation of the small or large intestine. 2. Perforation of a small bowel diverticulum. 3. Perforation of a duodenal ulcer. If appendicit...

Understanding Post-Meal Vomiting: Causes, Diagnosis, and Treatment Options

Hello Doctor: I have been experiencing headaches since 2011, and starting in April 2012, I began vomiting every time I ate. Initially, I was vomiting white foam, but it progressively worsened, and I ended up vomiting almost all the food I consumed (vomiting started five minutes a...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, Miss: The condition is quite complex, and the team of physicians at the medical center will do their best to address each issue, but it requires your long-term patience and cooperation for management. We are currently unable to provide further advice. Wishing you well... C...