The former president had six surgeries since the attack in 2018. He had to undergo “extensive” and “large” surgery to remove adhesions and rebuild the abdominal wall.
According to the medical bulletin released on Sunday (13), the procedure performed in about 12 hours, “passed non -complications and did not require”.
“At the moment, the former president is hospitalized in the UCU (Intensive Care Unit), clinically stable, without pain, and receives clinical, nutritional support and prevention measures,” the note concludes.
Cardiologist Leandro Echenique, who accompanies Bolsonaro, stressed that such procedures can lead to “to a series of complications.”
“There is an increase in the risk of some infections, needing medications to control the. There is an increased risk of thrombosis, problems of …”, said the doctor during a news conference on Monday (14).
“All preventive measures will be taken, so it is in the ICU right now.”
Echenique added that Bolsonaro’s postoperative period will be “very delicate and prolonged” and that there is no forecast of discharge.
Surgeon Claudio Birolini, head of the team who performed the procedure, described the former president’s abdomen as “hostile” because of the multiple surgeries which he had to be underwent.
“This already anticipated that it would be a very complex and laborious procedure,” Birolini commented to journalists.
Bolsonaro on Friday (11), when he participated in events in some cities in the interior of the
The former president had severe pain in the abdomen, had difficulty eating and digestion and was in a hurry.
He was transferred to Natal, the state capital, and then taken in a mobile ICU to Brasilia, where he underwent surgery.
Bolsonaro has frequent intestinal obstructions, which are related to
Doctors heard by BBC News Brasil explain that the emergence of such adhesions – a kind of fibrous scar – can happen in the face of any procedure in this region of the body.
But the factors that lead to this picture or the reasons of some patients develop it and others do not know for sure.
Those who have adhesions and suffer from paintings, such as Bolsonaro, are usually treated conservatively, with fasting and probes, but may need surgeries to solve the problem.
However, these procedures increase the risk of new adhesions – and of new interventions.
What causes the intestinal obstructions of Bolsonaro?
On September 6, 2018, Bolsonaro attended a campaign event in Juiz de Fora when.
The blow, which was quickly sent to a unit of and then to a operating room, where he passed the first interventions.
The next day, Bolsonaro was transferred to a hospital in Sao Paulo, where he underwent a second surgery on September 12.
The goal was to remove the first adhesions – a species of fibrous scar that emerged after the first operation – which obstructed its intestine.
The surgeons took advantage of the procedure to correct a fistula – an anomalous communication channel that appears in the body – developed in one of the sutures made during the first operation.
In an interview with BBC News Brasil, doctor Raphael Di Paula, chief of cancer surgery at the German Hospital Oswaldo Cruz, in São Paulo, explains that adhesions may arise when peritoneum, a membrane that covers the interior of the abdomen, is violated.
“Every time you enter the abdominal cavity to do any procedure, from the simplest to the complexes, can generate adherent processes,” says the doctor, who was not directly involved with the case of Bolsonaro.
“From the moment you make an intervention there, it can generate a kind of irritation or inflammation that leads to scars and adhesions.”
Di Paula points out that there are no risk factors or known characteristics that explain the reasons why some patients develop these reactions, while others never have this problem.
One of the only reasons, according to him, is the intestinal perforations – when the walls of this organ suffer some kind of rupture and part of the internal content extravasates to the rest of the abdomen.
It is known that this happened to Bolsonaro: the stab even pierced an excerpt from his gut.
Why is it recurring?
In January 2019, already in the position of president, Bolsonaro had a third surgery – this time, to remove the colostomy bag that collected the feces from an opened hole in the abdomen.
At the time, doctors found a large amount of adhesions in his digestive system.
In practice, the process of postoperative healing was causing excerpts from his gut to glue.
But this brings a problem: the intestines perform a series of movements to “push” food, digest nutrients and discard what is left in the form of feces.
The adhesions, however, “attach” or “tie” these organs, leaving them without the mobility necessary to function properly.
This can generate folds in the digestive tract that prevent the passage of very important foods and enzymes.
Gastroenterologist and surgeon Flávio Quilici, professor at PUC (Pontifical Catholic University) of Campinas, explains to BBC News Brasil that the intestines have a structure similar to that of pipes or hoses.
“If you step into the hose or enter some stone inside, it causes a clog that doesn’t let the water pass,” says Quilici.
The same reasoning applies to our digestive tract: If something is stuffed inside, there is no way the content is transit through the organs and move on.
Bolsonaro also underwent operations to correct hernias – okay leaks from the abdominal wall related to numerous incisions and interventions – in September 2019 and September 2023.
How is the treatment of an intestinal obstruction?
Di Paula explains that, most of the time, the treatment of intestinal obstruction does not involve surgeries.
The first step is to leave the patient fasting and pass a nasogastric probe (which goes from the nose to the stomach).
The goal here is to reduce the presence of gases and liquids that are tight in the digestive system and generate symptoms such as swelling and pain.
These treatments relieve the picture – with this, the intestine can clear and return to function normally.
However, there are cases where this organ is very double and there is no way to return to normal. The path, then, is to go to a more invasive procedure.
The size of the operation will depend on the degree of obstruction.
“There are cases where you have only one bridge [uma cicatriz fibrosa]which very much resembles the thickest rope of a guitar. Then you need to go to the place, in a minimally invasive procedure, and cut. It’s a second, and it’s over, “says Di Paula.
In other situations, adhesions are more extensive. Hence it is necessary to have conventional surgery, open the abdomen and remove all scars that stick the intestines and other organs of this region.
Di Paula details that these interventions can be “absurdly complex” and take hours. In the case of Bolsonaro, he spent this time 12 hours in the operating room.
“Often, it is necessary to remolve all intestinal handles. We need to practically sculpt the organ, until releasing everything and find the point where the obstruction is,” he adds.
Some patients have necrosis, or death of a stretch of intestinal tissue. In these situations, the surgeon needs to make cuts to remove affected parts and reconnect the organ again.
Di Paula says that although complex and time consuming, these procedures often have “a very good prognosis”, with a complete restoration of intestinal transit.
How to avoid new surgeries
The point is that these operations also increase the risk of new adhesions in the future.
On the one hand, they are necessary to solve intestinal obstruction and restore the flow of the digestive system.
On the other hand, in patients who already have history, they represent a risk of new fibrosis and scar formation processes – which in turn may further decrease abdomen mobility and cause new obstructions.
“The more the peritoneum is violated, the more we move in these intestinal handles and the abdomen, the greater the risk of new adhesions. The tendency is to be stronger, firm and complicated,” Di Paula recalls.
“This does not mean that the patient will necessarily have new obstructions, but he has a greater probability of suffering from this picture again,” he ponders.
Unfortunately, there is nothing that can be done to avoid the formation of adhesions and the development of intestine blockages.
“We need to count on the chance that it doesn’t happen again,” he says.
“There is no recommendation for the patient to do more or less physical activity, stop eating something, add something to the diet, take a medicine … Unfortunately, there is no evidence of something that is indicated in these cases,” he continues.
“It is only necessary to maintain a monitoring of the clinical picture,” he concludes.
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