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Child had pyloric stenosis. Regular pain around scar, hernia found. Now what can be done?

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General & Family Physician
Practicing since : 2008
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My daughter had pyloric stenosis at four weeks. The incision opened slightly before discharge and was treated with silver nitrate for a granule a and the surgeon said if she wanted it revised later if she didn't like how it looked. Fast forward years later and she complained of regular pain around under the scar but nobody could find anything wrong. Finally took her to a plastic surgeon who went in to revise the scar and instead found a hernia that had likely been the source of the pain for years. One year later and she is still complaining of pain. Now what? They did a ultra sound and found the incision was well healed and said perhaps she had shingles and prescribed lidoderm patches. Still complains of pain. She is 15 now.
Posted Mon, 24 Sep 2012 in Child Health
Answered by Dr. Raju A.T 1 hour later

Thanks for your query.

I would like to know some more details on the condition so that I can understand and opine better.

Is the pain XXXXXXX inside , over or around the scar ?
Is the pain intermittent or continuous ?
Is there any relation between the pain and food intake ?
Was the hernia found, treated ?
Are there any lesions around the scar ?

Waiting for your reply.
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Follow-up: Child had pyloric stenosis. Regular pain around scar, hernia found. Now what can be done? 15 minutes later
Intermittent pain, doesnt not appear to be related to food, pain is inside but she also wont allow anyone to touch it so i assume it is also around and on top of the scar. The hernia was found and repaired during the revision surgery. Surgeon said he should have done an ultrasound before the surgery but didn't because it appeared to be a straightforward revision. She reports increased pain during exercise, any stomach related activities ie. Crunches etc. We have seen her pediatrician and had negative ultrasound and bloodwork. No lesions.
Answered by Dr. Raju A.T 9 minutes later

Thanks for the information.

Based on the description , the pain appears to be due to soft tissue adhesions due to the scars formed from surgeries done in that region.The hernial repair if not coupled with releasing the adhesions, the procedure could have aggravated the pain as tension in the tissue beneath the skin and the viscera is artificially increased in the procedure.

I would ask you to get a repeat Ultrasound scan done and at-least for two more times.Ultrasound is one of the best as it captures images when the insides are in motion.The adhesions could become evident sometimes due to the bowel movements.If the radiologist who performs the scan is ask to look for the adhesions , a special care would be taken not to miss it by a long duration scan or repeat scans.The adhesions if made out then surgery involving their release would put an end to her problem.

Hope I answered your query.

Wish her a speedy recovery.

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