A summary of the key events for Whipple Surgery, Pancreaticoduodenectomy, the complete story.

A summary of the key events for Whipple Surgery, Pancreaticoduodenectomy. 

Private document, may only be used with written permission from Scott MacTavish.

Warning contains medical graphic picture links.

(spelling mistakes were “direct copy” from copied notes).

Family History: “A 60-year-old male with a history significant for Familial Adenomatous Polyposis (FAP). Due to this condition the patient had a previous colectomy in March 1980, and has been undergoing surveillance EGDs since that time. His dad died of duodenal cancer in Feb 1980.”

Jul 18, 2023 EDG Endoscopic, Reports: “Abnormal mucosa in the 2nd part of the duodenum. Innumerable diminutive polyps.  Extensive large flat adenoma no obvious malignancy, attempted removal, due to limited mobility / angulation of scope polyp could not be removed. There was a tiny erythematous area in the polyp with attempted biopsy but not possible due to above”

Jul 18, 2023 ENDOSCOPY, SIGMOID Reports: “Abnormal mucosa. Anastamosis ~20cm from anal verge. Eleven diminutive colonic polyps removed with cold snare and retrieved. Numerous scars throughout colon”

Aug 18, 2023 Surgical Pathology, Reports: Final Diagnosis

A. Small intestine, duodenal polyp; endoscopic biopsy:

- Duodenal mucosa with low-grade dysplasia/adenoma

B. Colon polyps x 11; polypectomy:

- 10 fragments of tubular adenoma; negative for high grade dysplasia,1 fragment of hyperplastic polyp

 

Nov 17 2023 Whipple Surgery “ Anesthesia Start: 10:00, Anesthesia Stop: 14:30”  20231117_064502.jpg

Nov 17, 2023 Nurses note: “ attempted to stand at bedside but ++ dizzy and nauseated”. IMG_20231121_175254_249.jpg

Nov 18, 2023 Nurses note: 0610 “ having pain crisis” 14:08 “ Stood at bedside and marched - dizzy.”  23:18 “ At hs, 2 PA to walk short distance in hallway (to nursing station)”. IMG_20231118_163843_174.jpg IMG_20231118_163843_246.jpg

Nov 18, 2023 Started pantoprazole 40 mg

Nov 19, 2023 Nurses note: ” Epidural site tenderness/pressure.” “ min assist. walked x 1 in hallway & up to BR x 2”  20231119_144452.jpg

Nov 20, 2023 Nurses note: “ Patient ++ anxious on evenings due to fixation to back pressure (epidural site) as well as some motion illusions reported. ” “ Pt c/o headache and Rt jaw pain. No radiating to other areas. Not sure if it is from NG tube? Charge nurse aware. PRN lozenge given.”

Nov 22, 2024 Nurses note: “ Complains of pain to face, rt side of jaw and throat from NG tube. Wants to get the tube out. NG to Gravity but patient likes it to be on suction today.” “ Patient pulled out NG tube 1cm as he felt very uncomfortable and gagging.”

Nov 23, 2023 Nurses notes: “ Epidural to be stopped and removed on Nov. 24 @0900” “ NG removed @0655hrs, start CFD today.”

Nov 24,2023 Nurses note “ Abdomen +++ distended and firm.” “ Patient now complaining of 10/10 pain and laying in bed in fetal position holding abdomen.” “ Resident to come insert NG. While awaiting Resident patient put his finger down his throat and vomited” “ While awaiting Xray NG drained 500mLs of bile.” “ Recent changes: Pain crisis overnight with SOB and +++ firm abc. NG reinserted by resident at 0330.” “ Pending CT, form completed, IV access available.”

Nov 24, 2023 GR CHEST 1 PROJECTION-For NG placement Reports: “ Enteric feeding tube is noted, the tip projecting over the gastric fundus.”

Nov 25, 2023 Nurses note: “ Abd distended.”

Nov 26, 2023 Nurses note “ CT abdomen pelvis ordered on Friday. Still not done on Sunday.
Action: I spoke to CT tech on Sunday at about 1030 . She said they are aware and when I said that CT ordered Friday and patient is having increased pain and abdomen distended And the physicians are concerned about an anastomotic leak. She then said they would call for him next which they did.”  IMG-20231126-WA0039.jpg IMG-20231126-WA0040.jpg

Nov 26, 2023 CT ABDOMEN PELVIS ENHANCED, 1st CT scan, Reports: “ Postoperative changes after Whipple procedure with development of large intraperitoneal collection and pneumoperitoneum,concerning for an anastomotic dehiscence. It is suspected that the described intraperitoneal air originates from the stomach, raising concern for dehiscence of gastrostomy staple line.”

Nov 26, 2023 IR ABSCESS DRAIN INSERTION MULTIPLE CATHETERS, IR drains installed, Reports: ” Upon arrival the patient had copious amounts of purulent discharge from his abdominal incision site and is betting was entirely saturated, it is estimated that approximately 1.5-2 L of fluid had spontaneously discharged from his midline incision site.” “ Initially the upper abdominal fluid was accessed using a right upper quadrant approach and approximately 500 mL of thick purulent fluid was removed, similar in nature to the fluid which had previously spontaneously discharged.”

Nov 27, 2023 1st PICC line installed, TNP started IMG-20231126-WA0043 20231127_164809.jpg

Nov 29, 2023 Surgical Pathology, Reports: ” Duodenum, Ampulla, Pancreas (Head) and Bile Ducts, Pancreaticoduodenectomy: Non-ampullary adenomas (intestinal type), multiple - Largest adenoma measures 2.5cm and shows high-grade dysplasia.”  20231129_093054.jpg
 
Dec 2, 2023 ECG 12-LEAD

Dec 3, 2023 CT ABDOMEN PELVIS ENHANCED- Reports: “ Previously noted large collection within the right upper quadrant has significantly decreased in size compared to prior CT, however the large pelvic collection is now more discretely organized with peripheral rim enhancement consistent with evolving abscess.”

Dec 4, 2023 IR ABSCESS DRAIN INSERTION SINGLE CATHETER,- Pelvic drain installed Report: “ Under local anesthetic and ultrasound guidance, an 18-gauge DTN needle was advanced into the pelvic fluid collection using an anterior midline approach taking care to avoid the bladder and adjacent bowel. Approximately 450 cc of cloudy, serosanguineous fluid was aspirated.”  20231228_220221.jpg

Dec 10, 2023 GR ABDOMEN 2 PROJECTIONS- Abdomen Xray, Reason: “ Abd distended/semi firm”. Reports: ” No distended loops of bowel to suggest ileus or obstruction.”

Dec 12, 2023 Nurses note: ” NG D/C`d”  20231212_094555.jpg

Dec 12, 2023 GR CHEST 1 PROJECTION- Chest Xray, Reason: “ Crushing chest pain @1200, heart issue ruled out. Relieved by PRN antacid”. Reports: “ The heart size and mediastinal contours are within normal limits.”

Dec12, 2023 ECG 12-LEAD

Dec 15, 2023 CT ABDOMEN PELVIS ENHANCED- CT Scan. Report : “ Shows increase in size of the large complex rim-enhancing collection within the right upper quadrant”

Dec 16, 2023 Dr Notes : “ Doing well, has some abdominal fullness but no nausea or vomiting, tolerating diet. Passing gas and BM.”

Dec 17, 2023  Dr Notes : ” Low apetite, on/off pain while eating, mobilizing, passing gas and BM, Pending IR drain”

Dec 18, 2023 CT CATHETER PLACEMENT FOR DRAINAGE SINGLE-Drain installed. Reports: “ Successful CT guided abscess drainage of the right upper quadrant collection.”  20231228_220229.jpg

Dec 22, 2023 CT ABDOMEN PELVIS ENHANCED- CT Scan. Reports: “ Interval decrease in size of rim-enhancing collections in the right upper quadrant, and pelvis. Possible filling defect is a left lower lobe posterior basal pulmonary artery which could represent pulmonary embolism. Dedicated CT pulmonary angiogram is recommended.”

Dec 23, 2023 CT CHEST PULMONARY ANGIOGRAM- Chest CT Scan. Reports: “ 0.7 cm subpleural pulmonary nodule in the LEFT lower lobe. This is probably a lymph node.”

Dec 30 , 2023 Lt. Thigh HDC for Octreotide 20231230_153006.jpg Nurses note: “ Octreotide discontinued, would like HDC line out”.

Jan 1, 2024 CT ABDOMEN PELVIS ENHANCED- CT Scan. Reports; “ Stable right upper quadrant collection and slight decrease in the pelvic collection. Slight increase in the anterior abdominal wall/subincisional collection which communicates with the right upper quadrant collection.”

Jan 2, 2024 Fistula picture 20240102_155437.jpg

Jan 3, 2024 Fistula pictures 20240103_120518.jpg 20240103_120656.jpg

Jan 5, 2024 Discharged from Hospital. Fistula pictures 20240105_103422.jpg 20240105_103803.jpg IMG-20240105-WA0062

Jan 6, 2024 Home Care note: “ There are 2 small opening in the incision which has a connected to a larger cavity under both wound openings”.

Jan 7, 2024 Home Care note: “ Removed dressing with large thick yellow seropurulent drainage”.

Jan 9, 2024 Fistula discharge picture 20240109_103154.jpg 20240109_103426.jpg 

Jan 12, 2024 Home Care note: “ Old dressing had a sweet smell with thick yellow pasty drainage. Looks consistent with stool but did not smell like waste.” 20240112_095135.jpg 20240112_155752.jpg

Jan 12, 2024 Emailed Medical team “ Home care nurse has been visiting each day, incision is still leaking out 2 places. It's a thick yellow paste. There is a yeast smell to the bandages/packing, wound area. I have attached a few pictures.”

Jan 13, 2024 Fistula discharge pictures Jan 13_110239.jpg 20240113_110240.jpg 20240113_111244.jpg

Jan 15, 2024 Fushing drain, wound manager pictures 20240115_083513.jpg 20240115_083741.jpg

Jan 16, 2024 Home Care note: “ The 3 small wounds and drain exit site are all developing hyper granular tissue.”

Jan 17, 2024 Wound manager picture 20240117_081100.jpg

Jan 18  Appointment with Surgeon's assistant, started Creon. Drain removed? Not sure but maybe pelvic drain.

Jan 18, 2024  Took Creon, 1 pill Jan 18, 2 pills Jan 19, 1 pill Jan 20, did not feel well, so had to stop.

Jan 19, 2024 Home Care note: “ Wound opening significantly smaller and slightly hyper granulated.” 20240119_111836.jpg

Jan 20, 2024 Emailed Medical team “ Last evening at 7 pm I started to experience Cramps, pressure, tenderness of the abdomin and strange feelings in throat/stomach, like some thing is stuck there or touching it. Something has changed and not if it is good or bad at this point. “

Jan 21, 2024 Wound manager picture 20240121_094826.jpg

Jan 23, 2024 Emailed Medical team “ Today was better until this evening had a few sharp pains and bloating. This all seem to start last Friday, and not sure why.”  20240123_093756.jpg

Jan 24, 2023 Started taking Creon again on Jan 24, 2024 ( 4 pills). Continued taking Creon, Jan 25 ( 3 pills), 26 ( 4 pills), 27( 3 pills).

Jan 26, 2024, Note I made on my phone “ noticed strange stringy material coming out of fistula”. 20240126_115133.jpg 20240126_123027.jpg 20240126_123144.jpg 

Jan 26, 2024 Home Care note: “ Noted adhered pale white slough coming during flushing.”

Jan 27, 2024 Note I made on my phone “ now 2 openings to fistula with stuff hanging out them.” Wound manager leaked then fell off 11pm.  20240127_232745.jpg 

Jan 28, 2024 Readmitted to Hospital.

Jan 28, 2024 CT ABDOMEN PELVIS ENHANCED- CT Scan. Reports: “ midline laparotomy site, there is a skin defect with increased size of a subincisional collection which now contains fluid and scattered foci of gas throughout.”

Jan 28, 2024 Nurse Notes: “ Writer assessed patient and found dressing, including abd pads, completely soaked with bile to the point of dripping.Writer removed the dressing and found a puddle of bile with mucous underneath. Cleaned with moist towels. Incision had large attached lump of slough. Writer cleaned around it several times. Skin surrounding was excoriated and painful. After a few wipes, hte slough piece lifted on the right then completely, to reveal a crater-like hole approximately the size of a golf ball and about 2cm deep.” “ In the hole there is a black stitch that is rigid string.”EMR Report-9.png 20240129_020315.jpg EMR Report-273 copy.png 20240129_040238.jpg 

Jan 29, 2024 Nurses note: “Team to reassess plan regarding NPO & PICC/TPN tomorrow, as well as maybe starting Octreotide.” Plan for 2nd PICC line and TPN( was talked about but didn’t happen on this date)

Jan 30, 2024 Nurses note: “ The skin around the opening of the wound was extremely sensitive, some bleeding noted at 6 o'clock. Redness noted on the skin
around the wound. Two blue sutures are visible within the abdominal cavity. The drainage appeared more yellow and thin compared to earlier, when it appeared to be thin green fluid (?bile).”  20240130_093005.jpg

Jan 30, 2024 RF PATIENT CONSULTATION (IN PERSON)-Fluoroscopy ordered, but changed to an MRI Reports: “ DI Procedure not preformed due to radiologist wanting Pt to get MRI first “

Jan 31, 2024 MR ABDOMEN W WO ENHANCEMENT- MRI Reports:  “These MRI findings confirm the presence of a leak from the hepaticojejunostomy site.”

Feb 2, 2024 IR BILIARY DRAINAGE ONE BRANCH- IR BILIARY DRAIN. Reports: “ Unsuccessful attempt to place a biliary drain” 20240202_124247.jpg

Feb 3, 2024 GR CHEST 1 PROJECTION- Chest Xray. “ Complains of heart burn evening shift” Nothing strange to report  20240203_150215 (1).jpg

Feb 4, 2024 GR ABDOMEN 2 PROJECTIONS- Abdomen Xray for abdominal pain. Reports: ” Nontracking bowel gas pattern with air in the rectum”.  20240204_141933.jpg

Feb 4, 2024 GR CHEST 2 PROJECTIONS- Chest Xray Reports: ” No evidence for pneumonia.”

Feb 4, 2024 CT ABDOMEN PELVIS ENHANCED- CT Scan Reports: “ small collections of hyperdense fluid (and air) in the anterior right upper quadrant and midline. New portal vein thrombus throughout the horizontal and ascending branch left portal vein extending into segment II and III portal veins”.

Feb 5, 2024, Nurses note: “CT Abd/ Pelvis shown Thrombus,no evidence of gastrojejunostomy leak. Heparin infusion start today”.

Feb 6, 2024 IR PATIENT CONSULTATION (IN PERSON)-  IR BILIARY DRAIN 2nd attempt. Repots: “ No intervention performed at the present time due to virtually no bile duct dilatation or unexpected complications”.

Feb 7 Periolim IV feeding and Octreotide started 20240207_185739.jpg Heparin may have stopped this day?

 Feb 8, 2024 Dr Note: “ Red rubber catheter inserted into the fistula. Plan for sinogram”.  20240208_094322.jpg

Feb 12, 2024 RF SINOGRAM- Fluoroscopy Reports: “ A small amount of contrast is seen opacifying the biliary tree.”  20240212_115342.jpg

Feb 15 PICC line ordered then cancelled. After discussion with Resident Dr and NP PICC was re-ordered and started TNP feeding. No notes of this were made other than my private notes on my phone. “ PICC line oredered, then canceled at last minute, and asked to start eating. Didn't make sense to me so asked to stay on original plan un till stent attempt in 7 days. Out put to Wound manager is down, I thought that was the goal of the IV Perolimel feeding? Now will be on TPN feeding, better nutrition to help healing.”

Feb 15, 2024 2nd PICC Line installed, TPN feeding started. 20240216_175409.jpg 

Feb 15, 2024 GR CHEST 1 PROJECTION- Chest Xray, Confirm R PICC tip placement

Feb 18, 2024 GR CHEST 2 PROJECTIONS- Chest Xray. Cough Reports: “ Few linear opacities in the right mid to lower lung favored may relate to atelectasis.”

Feb 19, 2024 Picture of Fistula 20240219_111809.jpg

Feb 22, 2024 IR BILIARY DRAINAGE ONE BRANCH- IR BILIARY DRAIN 3rd attempt. Reports: “ successful insertion of a right-sided 10 French internal/external biliary drain.” 20240222_180222.jpg 20240223_063800.jpg

Feb 22, 2024 IR NERVE ROOT INJECTION

Feb 27, 2024 Nerve block installed. ” Nerve block installed. Helping with the pain around the drain.”

Feb 29, 2024 Picture of Fistula 20240229_113504.jpg

Mar 3, 2024 Old stitch was removed from fistula. It was originally noted on Jan 29, 2024 Nurses note: “ In the hole there is a black stitch that is rigid string.” and again on Jan 30, 2024 “ Two blue sutures are visible within the abdominal cavity.”

Mar 6, 2024 Start drinking water to see if fluid out put of fistula changes.( sips of water Mar 6 to 12th).  20240306_101306.jpg

Mar  5, 7, 13 Mar 14 2024 I note: “ burping gas from the fistula, felt hungry, fistula was very active. This is before I ate breakfast. Active on and off all morning, same old thing feel hungry, rumble of belly then  a burp of gas.” I am sure I talked to the team about the gas burping after the stomach rumbled, but don’t see any notes of this other than mine. 20240307_143808.jpg 20240308_145854.jpg 20240310_092115.jpg 20240310_184116.jpg

Mar 13, 2024 Clear Fluids started I noted:  “ red tint to the gauze, must be from the red jello I had at breakfast?” 20240313_165241.jpg 20240313_165314.jpg

Mar 14, 2024 Full Fluids started I noted:  “ 5pm, paste  looks like chocolate insure,” had a chocolate insure earlier, took pictures and showed team. 20240314_165722.jpg 20240314_170813.jpg 20240314_170822.jpg

Mar 15, 2024 RF SINOGRAM- Fluoroscopy Reports: “5 0 cc water-soluble contrast was injected “nto the fistula via this catheter and immediately opacifies the stomach through opening in the oversewn distal end of stomach. Confirmation that the opacified structure is stomach.” 20240315_075234.jpg 20240315_134020.jpg

Mar 15 to 19  TPN at Night and full fluids in day, not sure why I kept taking in fluids by mouth for 4 more days? 20240316_195401.jpg 20240316_195522.jpg 20240317_194744.jpg 20240317_194920.jpg

Mar 18, 2024 IR BILIARY CATHETER EXCHANGE. Reports: “ Uncomplicated successful exchange of the right-sided internal/external 10.2 French biliary drain.”

Mar 19, 2024 Fistula picture 20240319_111201.jpg

Mar 20,2024 “INR sent today at IR request.” I think this was a request for a feeding tube.

Mar 20, 2024 GR CHEST 1 PROJECTION- Chest Xray confirm NG position, feeding tube ordered, but not installed. 20240320_160903.jpg

Mar 21, 2024 Fistula picture 20240321_145457.jpg

Mar 23, 2024 Fistula discharge picture  20240323_183705.jpg

Mar 26, 2024 Fistula, wound picture 20240326_073530.jpg 20240326_174042.jpg
 

Mar 27, 2024 GR CHEST 1 PROJECTION- Chest Xray confirm NG position feeding tube ordered, but not installed.

Mar 28, 2024 Fistula picture 20240328_060000.jpg

Apr 1, 2024 Fistula picture 20240401_064009.jpg

Apr 2, 2024 I noted  “ Clean gauze, no out put since  9 am the day before. Just some dryed blood around fistula. “ The day the fistula seem to close over.  20240402_063211.jpg 20240403_062536.jpg

Apr 4, 2024 RF GASTROINTESTINAL TUBE POSITIONING Fluoroscopy . Reports: “ Successful insertion of silastic feeding tube into the enteric loop of the jejenum.” 20240404_102301.jpg

Apr 4, 2024 Started NJ tube feeding, with plan to transition off TPN feeding.  20240404_103709.jpg 20240404_204115.jpg

Ap 5, 2024 Started trying to use Creon in the feeding tube.

Apr 7, 2024 Nurses note: “ Writer called pharmacy around 0800 h to inform that the Cotazym medication is actually not going inside the NJ tube completely despite having to soak the pellets in water during the night shift, which was given at 0600 h by night nurse. Writer asked pharmacist for alternatives since the medication can't be crushed. As per pharmacist, try to call the Dietitian on call as she doesn't want to alter the medication at the moment since it's being titrated. Charge nurse informed of same. Dietitian on call informed.”

Apr 8 , 2024 I noted “ 735 shut tube feed off, went back to room, really painful lower right, felt like and obstruction 930 extremely pain cramps, maybe an obstruction. Haven't felt anything like this in years, or ever.”

Apr 8, 2024 GR ABDOMEN 2 PROJECTIONS- Abdomen Xray, concern for obstruction. Reports: “ The radiographic findings mayreflect an early/developing small bowel obstruction.”

Apr 9, 2024 Started NJ tube feed again( still TPN at night)

Apr 10, 2024 Fistula picture  20240410_060513.jpg

Apr 11, 2024 Had to shut off NJ feed again because of cramps.  Nurses note: “At ~1745hrs patient complaining of abdominal cramps/distention and requesting to turn off feed for the night. Patient states he feels constipated and that he had one bowel movement today but it appeared "greasy". Enzymes were discontinued by dietician yesterday due to difficulty flushing same down NJ tube.”

Apr 12, 2024 Started taking enzymes mixed in water in NJ tube. I think this when I switched to Viokace because the Creon wouldn’t mix with water. There is no mention of Viokace in the records.

Apr 12, 2024 Had visit with Hospital GI Dr about colonoscopy. Recommended I follow up with my original GI Dr.

Apr 14, 2024 Started to notice  “ bump on left side upper of fistula” almost like something had moved inside, it’s still there to this day. X rays ordered.  20240414_190331.jpg

Apr 15, 2024 Noted “ lump still on upper left of fistula, not sore or tender. Dr team saw it will do and xray.”
Colonoscopy is canceled, book for later with GI Dr. “ Nurses note: “Sigmoidoscopy cancelled, GI says should wait for another month before his thrombus resolves, can be done with his own GI as outpatient”

Apr 15, 2024 GR ABDOMEN 2 PROJECTIONS- Abdomen Xray, Focal pain LUQ. Reports: “Several air-fluid levels within several nondistended loops of bowel within the central abdomen and pelvis.”

Apr 15, 2024 GR CHEST 1 PROJECTION- Chest Xray, Per Protocol. Reports same as above Xray

Apr 17, 2024 CT ABDOMEN PELVIS ENHANCED- CT Scan. Reports: “ Internal/external biliary drain with interval resolution of the previously seen right upper quadrant and abdominal wall fluidcollection, known to represent a bile leak. No new collection. Now chronic thrombosis of the left portal venous system with decrease in caliber”.

Apr 22, 2024 Fistula picture 20240422_052542.jpg

Apr 23, 2024 TPN feeding stopped, intake with NJ feeding was at max rate over night.

Apr 27, 2024  Doctors note: “ 4/28: Complaining of nausea that started last night and continues this am. Stopped octreotide yesterday and I am suspicious that the nausea is related to coming off of it. We are going to work with anti-emetics today and try to ride through the nausea rather than go back on the octreotide.” Octreotide started Feb 7, 2024,

Apr 29, 2024 Discharged from Hospital.

May 3, 2024 Surgical Pathology, Reports: Colon Polyps x 34 Polypectomy:
-Tubular adenomas x 30
-Negative for high-grade dysplasia
-Hyperplastic polyps x 4

May 14, 2024 Fistula picture 20240514_083236.jpg

May 15, 2024 Hospital visit GEN SURG ACESS CLINIC. nothing new to report.

May 24, 2024 RF GASTROINTESTINAL TUBE POSITIONING- Fluoroscopy. Reports: “ Indwelling Silastic feeding tube has been removed and replaced with a new Silastic feeding tube”. 20240524_120050.jpg 

May 29, 2024 IR BILIARY DRAIN Removed. 20240529_092657.jpg 

Jun 20, 2024 Hospital Visit - General Surgery Clinic. Review Apr 17, 2024 CT scan with Medical team.  Screenshot_20240620.png

Jun 24, 2024 Scab fell off fistula. 20240624_070243.jpg  20240624_070339.jpg 20240624_210049.jpg 

July 4, 2024 Hospital visit - General Surgery Clinic. NJ Feeding tube removed.

Jul 12 CT ABDOMEN PELVIS ENHANCED Reports: “No significant adverse interval changes are apparent allowing for technical differences between the examinations. No evidence of abdominal wall or post operative collections. No evidence of enterocutaneous fistula identified.”

Jul 12, 2024 CT CHEST ENHANCED Reports: “Well circumscribed subpleural nodule overlying the superior segment of the left lower lobe posteriorly measuring 6 mm.”

Aug 6, 2024 Surgical Pathology, Reports: Colon Polyps x 26, Polypectomy:
- Tubular adenomas, negative for high grade dysplasia

Oct 3, 2024 Changed to Rabeprazole, and cut dosage in half compared to Pantoprazole.

Nov 26, 2024 Surgical Pathology, Reports: Colon, sigmoid, x 36 Polypectomy:
- Tubular adenomas, negative for high grade dysplasia

Nov 26, 2024 EGD (Esophagogastroduodenoscopy) Reports: “ Normal esophagus Gastrojejunostomy at mid gastric body greater curvature
Jejunum normal to ~30 cm of intubation”.