title: Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.
abstract: BACKGROUND
  It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems.
  
  
  METHODS
  We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically.
  
  
  RESULTS
  The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain.
  
  
  CONCLUSIONS
  The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.
authors.affiliation: Bariatric Surgery Center, Fresno, CA, USA. higanoid@hotmail.com
authors.forename: K D
authors.initials: KD
authors.lastname: Higa
authors.forename: T
authors.initials: T
authors.lastname: Ho
authors.forename: K B
authors.initials: KB
authors.lastname: Boone
authors.forename: M C
authors.initials: MC
authors.lastname: Roubicek
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000150:complications / Q000175:diagnosis*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012086:Reoperation; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D008691:Methadone