Vitamin B12 deficiency with Right Hemi-colectomy

Thank you for this. I need my B12 level to be checked. I too thought my fatigue was due to my age! 70 next birthday.

sbt19, I'm wondering if instead of the shots you might find you could use the sublingual high potency B12 pills to bring up your B12 levels. I had a right hemicolectomy for colon cancer in 2022 ( they removed the cecum, ascending colon and as much of the transverse colon as needed to get good margins past the tumor they found in the hepatic juncture of the transverse colon- diagnosed as stage IIa adenocarcinoma). I've taken these sublingual B12 pills and that seems to have kept my B12 levels adequate. These pills are 2500 mcg, the sublingual method ( under the tongue) allows for better absortion of the vitamin than swallowing B12 pills, and they're inexpensive and available in any pharmacy or anywhere they sell vitamins. Just a thought to maybe be able to avoid those monthly injections.

My B12 level is checked annually by my PCP.

Mary bird, maybe once I can get my level up to where it needs to be, I may be able to switch to the sublingual tablets or liquid drops. Right now I need the shots because I am so low. I have been having tingling/numbness in my hands and thought it was carpel tunnel. My surgeon says B12 deficiency could be causing this because it ca affect the nerves.

Glad you are doing well after your surgery and that you knew about needing the B12 supplementation. Wish I had been more informed.

@sbt19 I wasn't informed specifically about the association of B12 deficiency with the hemicolectomy, but my PCP checks B12 levels annually as part of the lab testing. And following my surgery I was seeing an oncologist and they check lab results for every visit. I was also anemic ( mostly iron deficient, I think) and they checked B12 and folate levels as well. I received a couple of B12 shots there after the surgery, but my levels increased and stabilized and that's when I was instructed to take the B12 sublingual pills.

From what I'm reading, B12 is absorbed mainly in the terminal ilium, the last part of the small intestine. I've never been able to figure out if I still have my terminal ileum, it wasn't mentioned in the operative report, the last portion of the small intestine was attached directly to the remaining transverse colon after the removal of my cecum, ascending colon and portions of the transverse colon containing the tumor. Yet it looks as though the pathology report with the gross description of the tissue mentions the terminal ileum as present in that issue. So I don't know.

As you can see from the articles below, B12 absorption is a complex process and there are any number of issues that can arise that may compromise this absorption, this can occur whether or not the ileum is present. Often B12 deficiency is attributed, especially in older individuals, to not enough gastric acid to properly break down the foods, and may be seen in people who take a lot of antacids to control GERD and other gastric issues.
https://perniciousanemia.org/b12/absorption/
https://www.ebmconsult.com/articles/vitamin-b12-absorption-mechanism-intestine-intrinsic-factor

Thanks, Mary bird, for the article links.
I believe it is standard procedure to remove the terminal ileum in a right hemicolectomy. The terminal ileum is narrower than the rest of the small intestines. In order for a good fit for the anastomosis to connect the remaining large intestines to the small intestines, the terminal ileum would be too narrow.

Thanks, I had the same surgical procedure…will ask doc about B12.

@ thanks—just reviewed surgeon’s notes and will look into B12.