Almost too late
“Did you know a person can bleed to death without knowing?”
My friend Jack was telling me about the period a day or two after his operation while in intensive care and he could not sleep.
“The hours came dragging their feet behind time. I thought half an hour or more should have passed. Then it was not even five minutes. Unbelievable how slowly time can pass when you are in discomfort and pain in relation when how quickly the same time pass during a holiday.”
Jack had an operation which he should have had about sixty years ago. The reason why he did not have the operation was that nobody knew he had the disorder. Even though he had aches and pains during his life because of the disorder, it was never severe enough to prompt an investigation into the matter. The symptoms could be because of various reasons and it was the other possibilities that the doctors accused.
The situation changed approximately two years before Jack had his operation when his wife told him she thought he was losing weight. He told her she imagined it and did not take it seriously. However, the scale told him differently. After a while, Jack realised his wife was correct. He lost about five kilograms during two to three months.
Losing weight can be good, but not without reason. Also, his bowels were irregular, changing between diarrhea and constipation. Another symptom was that Jack could not eat. His wife prepared the tastiest food, but he could not even eat half as much as usual. His stomach felt uncomfortable and he started to vomit.
Jack became worried about the possibility of cancer. He decided to see a doctor who referred him to a specialist. After a colonoscopy and endoscopy, Jack was diagnosed with a stomach ulcer, an obstruction in the bowels, and a hernia in his diaphragm. He had to take tablets prescribed for six months to cure the ulcer. After six months Jack was to go back for a check-up. At the end of the six months, Jack wanted to go on holiday but realised he could not live without the tablets. The moment he stopped taking the tablets, he was back to square one. Severe stomach aches and irregular bowel with vomiting.
He asked for another month's prescription and enjoyed his holiday. After the holiday he realised he was in trouble. He could not eat at all.
`Before Jack could get to the doctor, he happened to be home one day. He got up from the chair he was sitting in to go to the kitchen. When he got up, Jack felt very dizzy and had to hold on to a cupboard in the kitchen. It was about ten o'clock in the morning. That was the last Jack could remember. His wife found him curled up in a chair half-past three the afternoon where he passed out.
His wife took Jack to casualty from where he was admitted to hospital.
The doctor wanted to operate immediately, but for some unknown reason, the doctor felt uncomfortable about the operation. Jack was also too weak with his blood count far too low. Jack might not have survived the operation. Jack lost too much blood. The doctor decided to do another colonoscopy and endoscopy. The result was shocking. Instead of healing due to the medication, the damage from the ulcer was twice as much as previously.
The doctor accused Jack of popping pain tablets as this would be the only reason for such a result.
“But I never took even one tablet!” Jack tried to convince the doctor.
According to the doctor stomach ulcers are caused by tablets, smoking, or alcohol. Which would it be? In Jack’s case not one of those reasons. But the doctor did not believe him.
Jack was sent home with a prescription of Topzol which he had to take twice a day for two months and a strict diet of liquidised soup at specified times during the day.
“And do not eat more than half an hour outside a set time”, the doctor commanded. Jack did exactly as he was told.
Jack lasted two weeks. Then his stomach blocked up again. Jack also thought the ulcer started to bleed again and he ended up in the hospital a second time. This time the doctor only stabilised Jack and sent him home to carry on with his strict diet and double dose Topzol.
A week later Jack experienced severe lower back pain and decided to go back to the doctor. He was in such pain he could not walk straight up and even his voice was weak. He got an appointment squeezed in between other appointments with the doctor for the next day.
“That night was the worse night of my life. The lower back pain was agonising. I felt like dying. In fact, my wife told me she saw death in my eyes.”
The doctor arranged for Jack to go back to the hospital in two days’ time, but it turned out Jack went the following day. He could not bear the pain. As the saying goes, third time lucky.
“The problem was that the back pain did not relate to the stomach. Normally lower back pain is a result of problems with the intestines, not with stomach trouble.”
The doctor realized there was only one way to solve the problem. He had to operate. The operation took place the next day and lasted four hours.
Apparently, when the doctor started cutting, a dragon head popped out of Jack’s stomach which gave the theater sister a big fright. The dragon was Jack’s blown up intestines.
After the operation, the doctor discussed the operation with Jack’s wife. As he walked up to her he just shook his head and wiped his forehead.
“You will not believe it, “he said. “It was a Meckel diverticulum and a volvulus. Do you know what is a Meckel?”
A Meckel diverticulum is a bulge in the small intestine at birth and a remnant of the vitelline duct or yolk stalk. This represents a malformation in approximately two percent of the population, mainly males. This malfunction was found in the sixteenth century by Fabricius Hildanus but only explained in 1809 by Johann Friedrich Meckel.
In most cases, there are no symptoms, but if symptoms do occur, it is normally within the first two years. Symptoms are rectal bleeding, followed by intestinal obstruction, volvulus, and intussusceptions. Other symptoms are severe stomach aches and bloating. The symptoms can be confused with that of an appendix. As the Meckel diverticulum is outside the intestines, it cannot be picked up by a colonoscopy or endoscopy.
“When I was younger, I used to experience severe stomach aches that would spread to my back. I thought it was back trouble and went to a chiropractor. Nothing helped.”
Jack also ended up in hospital for a week at the age of about 38 because he could not eat without vomiting. The doctor almost took out his very healthy gallbladder, but luckily realized in time it was not necessary. The reason for his problem at that time remained unknown.
As the vitelline duct is made of pluripotent cell lining, the Meckel diverticulum may comprise abnormal tissues which could be jejunal, duodenal mucosa, or Brunner's tissue. In the case of Jack, the Meckel contained stomach tissue. Stomach tissue creates stomach acid.
Jack’s Meckel diverticulum grew bigger during time and ended into the stomach where it secreted stomach acid. This extra acid caused the stomach ulcer and the reason why normal treatment would not heal the ulcer. Instead of healing with the treatment, the ulcer became worse, regardless of the medication.
The extreme lower back pain Jack experienced was caused by the volvulus. A volvulus is when a loop of the intestine twists around itself and the mesentery that supports itself resulting in a bowel obstruction. If the twist is too tight, blood flow is cut off.
In Jack’s case, the volvulus made a double twist with a knot in the middle. That was why the intestine blew up like a balloon which created the dragon head at the start of the operation. The doctor had to cut the infected part of the intestine out.
The stomach was also flaked open and cleaned out during the operation and the obstruction in the intestines received the necessary attention.
“After 63 years I was almost late for the operation. I could have been dead before my wife picked me up originally. Then the intestines could have raptured because of the pressure of the built-up gasses inside. An hour or two later I could have been dead because of streptococcus.”
Jack was lucky. Except that he was in time for his operation, tests proved he had no cancer or any signs of streptococcus. He also believes that according to the doctor his problems are solved, and he should live a normal healthy life without a repeat of his former symptoms. If he had his operation when he was first admitted to the hospital, the ulcer would have been cut out of his stomach. The result would have been that Jack would have had a declined quality of life. Another fact is that if Jack had his operation the first time, the doctor would not have known about the volvulus and Jack would have had to go back for another operation.
Now the hours are not dragging its feet behind the time anymore for Jack. In fact, he would like some more time to fit all his activities in.