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My husband almost died due to a hole in his small bowel. Two

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weeks earlier he was in...
My husband almost died due to a hole in his small bowel. Two weeks earlier he was in a different hospital where he had a colonoscopy, endoscopy and a barium swallow x-ray. His problem 2 weeks ago was blood in his stool. Black tarry stools.
Shouldn't the hole in his small bowel been discovered from one of those tests? It took a different hospital and different Drs. to do a CT scan to find the hole. He also was told he has a benign gist in his small bowel. Do those ever become cancerous?
Submitted: 2 years ago.Category: Medical
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7/28/2015
Doctor: Dr. David, Board Certified Physician replied 2 years ago
Dr. David
Dr. David, Board Certified Physician
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Hello, this is Dr. David. I have read your question and I'm ready to help.
those test would not have seen a small hole in the small bowel.
a small hole in the small bowel would have leaked air into the abdomen.
so the best test to look for this is a KUB abdominal xray or an abdominal CT scan to look for free air within the peritoneum.
colonoscopy and endoscopy don't go into the small bowel.
a barium swallow xray would not necessarily see free air within the abdomen.
nothing can really see the small hole in the small bowel
but xrays and CT scans of the abdomen can see free air which is a sign there is a leak in the bowel
GIST is gastro intestinal stromal tumor which can be treated with chemo pills or surgery.
these need to be diagnosed with a biopsy.
did he have this GIST removed with surgery after the leak was found?
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Doctor: Dr Basu, Experienced Specialist replied 2 years ago
Dr Basu
Dr Basu, Experienced Specialist
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Satisfied Customers: 29,268
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Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

I have a different opinion.

It is likely the small bowel hole was created from the endoscopy.

So this is a man made hole most likely.

That is why it as seen in subsequent Ct scan but not sen in barium xrays.

If the hole were present before, it would have been seen in barium test easily.

So you can actually seek a medicolegal opinion from a lawyer also after reviewing the medical records.

Best wishes,
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Doctor: Dr. David, Board Certified Physician replied 2 years ago
This is Dr. David
the location of the small hole in the small bowel makes a big difference
the upper endoscopy scope only goes into the esophagus and stomach and a little bit into the duodenum or early part of the small bowel.
it is rare for endoscopy to cause holes in the bowel.
if the small hole was in the distal duodenum or jejunum or ileum, then the endoscopy would not have caused it.
did he have surgery to repair the small hole in this bowel?
did they see air on the CT scan to help them find the hole i the small bowel?
did he have a GIST lesion in his small bowel?
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Doctor: Dr Basu, Experienced Specialist replied 2 years ago

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

It does not matter the location of the hole,,

The endoscopes can cover almost whole length of the intestine and that is the likely cause of hole as a complication.

Hole in bowel wall can occur from poking from the endoscopy.

Also an ulcer can perforate through the wall sometimes from instrumentation.

Barium xray would have picked up the hole if it were present before endoscopies.

Best wishes,
It was my pleasure to help you today.
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Doctor: Dr. David, Board Certified Physician replied 2 years ago
This is Dr. David
the location of the hole does make a big difference.
upper endoscopies don't go past the duodenum of the small bowel
we can't do endoscopies into the small bowel
that is why we have to use a pill endoscopy to look into the small bowel.
that is not true that "endoscopies can cover almost the whole length of the intestine"
the vast majority of the small bowel can not be reached by upper endoscopy or colonoscopy.
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Doctor: Dr Basu, Experienced Specialist replied 2 years ago

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

Based on CT scan, the hole was present at the area easily covered by the endoscopes.

So this is likely endocope related complication.

Barium Xray did not show as the hole was not present before the endoscopies and the endoscopies were done after Barium xrays.

CT scan will pick up any hole caused bythe endoscopies.

Hence, this can be reviewed by an independent specialist by reviewing the records from both the hospitals.

Best wishes,
It was my pleasure to help you today.
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Doctor: Dr. David, Board Certified Physician replied 2 years ago
This is Dr. David
"Regular upper endoscopy cannot look very far into the small intestine because it is too long (20 feet) and has too many curves."
this is from the American Cancer Society Website on small intestinal cancers.
http://www.cancer.org/cancer/smallintestinecancer/detailedguide/small-intestine-cancer-diagnosis
GIST lesions are often found in the small bowel and can bleed and cause black tarlike stools.
that is from the blood being digested in the small bowel
GIST lesions can also cause holes in the small bowel and cause air to come out of the small bowel which can be seen on CT scan.
it sounds like he most likely had surgery to cut out this benign GIST lesion in the small bowel and fix the air leak which is good
GIST lesions can either be benign or malignant.
that is good his was benign.
usually they do not turn malignant, but he will need future monitoring of his stools to check for blood.
let me know if you have questions.
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Doctor: Dr Basu, Experienced Specialist replied 2 years ago

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

The bowel hole is not present at the GIST affected area.

The hole was likely present at the area well covered by the endoscopes.

If there was a hole before, Barium Xrays would have picked up as it travels through the entire intestine.

The leakage of barium dye from intestine will not be missed.

if it was missed that is still the radiologist's fault in the first hospital.

So, this was likely inadvertent injury from endoscopies.

I am glad that your husnad is doing better now.

But you should pursue this with an independent medical review of all the records.

Best wishes,
It was my pleasure to help you today.
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