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What Causes Constant Pain In The Abdomen After An Appendectomy?
Question: I am still in pain after surgery from a perforated appendix. The surgeon believes that the pain can be managed with vicoprofen. Not so. The pain, three weeks after surgery, is as intense as it was when I was discharged from the hospital. Help!
For pain management in the past (oral surgery, back pain, tubal ligation, other minor surgeries and injuries) I have taken:
Percocet 7.5/325
Lortab 10/325
Tylenol #3
Generic Oxycodone 10 (NOT OxyContin).
For pain management in the past (oral surgery, back pain, tubal ligation, other minor surgeries and injuries) I have taken:
Percocet 7.5/325
Lortab 10/325
Tylenol #3
Generic Oxycodone 10 (NOT OxyContin).
Brief Answer:
Please give additional information and post reports of investigations
Detailed Answer:
HI.
Thanks for your query.
To recapitulate: Female/53 - surgery for perforated appendix - three weeks ago - pain as intense as when you were discharged from hospital - Morphine after surgery for 3 days, then Vicoprofen oral PRN - used in past Percocet 7.5/325, Lortab 10/325
Tylenol #3, Generic Oxycodone 10 (NOT OxyContin) after other surgeries as mentioned - wants help.
Please give some additional information:
Was the surgery open one or Laparoscopic?
How may days were you admitted?
Any other intestinal symptom - like Bloating, loss of appetite, constipation or loose stools, nausea/vomiting?
Where exactly is the pain?
Any investigation like Ultrasound or CT scan or tests of blood, urine and stool done after surgery to find out the cause of pain? If yes, please post reports.
Any history of IBS or such a problem in past?
Ideally there should not have any pain after three weeks of surgery.
Hence needs a detailed history.
Please give additional information and post reports of investigations
Detailed Answer:
HI.
Thanks for your query.
To recapitulate: Female/53 - surgery for perforated appendix - three weeks ago - pain as intense as when you were discharged from hospital - Morphine after surgery for 3 days, then Vicoprofen oral PRN - used in past Percocet 7.5/325, Lortab 10/325
Tylenol #3, Generic Oxycodone 10 (NOT OxyContin) after other surgeries as mentioned - wants help.
Please give some additional information:
Was the surgery open one or Laparoscopic?
How may days were you admitted?
Any other intestinal symptom - like Bloating, loss of appetite, constipation or loose stools, nausea/vomiting?
Where exactly is the pain?
Any investigation like Ultrasound or CT scan or tests of blood, urine and stool done after surgery to find out the cause of pain? If yes, please post reports.
Any history of IBS or such a problem in past?
Ideally there should not have any pain after three weeks of surgery.
Hence needs a detailed history.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. Surgery was laparoscopic.
2. Pain is located in entire peritoneum from under breasts to lower pelvis. I little more painful on right side but painful on left as well.
3. Admitted for 13 days. WBC was high meaning my body was fighting an infection. CT scan upon admittance to hospital in ER, two more done as inpatient to locate problem (possible abscess, other fluid in peritoneum). Fluid located behind liver in right lower quad, procedure performed to insert drainage tube to collect fluid which was not infectious (5 days post-op). One drainage tube placed at surgery, other placed to diagnose why my white count was so high (5 days post-op). Both tubes taken out 10 days post-op then high-dose antibiotic and antifungal IV's began around the clock.
4. Other intestinal symptoms -- bloating, not much of an appetite, no constipation or loose stools, occasional nausea, no vomiting, occasional low-grade fever.
5. One CT scan done 6 days after discharge because of intense pain. Results unclear. Nothing prescribed.
6. No blood in stool, urine normal, WBC normal (though they wouldn't give me the number).
7. No history of IBS or other abdominal issues in the past. My bowels run very smoothly and I get regular colonoscopies. Due for another colonoscopy, awaiting appointment date from Doc office.
I do not have reports and do not know how to get them. Currently on Medicaid since hospital stay. I will contact my state Medicaid to obtain all medical records from hospital admittance until now.
Thank you
2. Pain is located in entire peritoneum from under breasts to lower pelvis. I little more painful on right side but painful on left as well.
3. Admitted for 13 days. WBC was high meaning my body was fighting an infection. CT scan upon admittance to hospital in ER, two more done as inpatient to locate problem (possible abscess, other fluid in peritoneum). Fluid located behind liver in right lower quad, procedure performed to insert drainage tube to collect fluid which was not infectious (5 days post-op). One drainage tube placed at surgery, other placed to diagnose why my white count was so high (5 days post-op). Both tubes taken out 10 days post-op then high-dose antibiotic and antifungal IV's began around the clock.
4. Other intestinal symptoms -- bloating, not much of an appetite, no constipation or loose stools, occasional nausea, no vomiting, occasional low-grade fever.
5. One CT scan done 6 days after discharge because of intense pain. Results unclear. Nothing prescribed.
6. No blood in stool, urine normal, WBC normal (though they wouldn't give me the number).
7. No history of IBS or other abdominal issues in the past. My bowels run very smoothly and I get regular colonoscopies. Due for another colonoscopy, awaiting appointment date from Doc office.
I do not have reports and do not know how to get them. Currently on Medicaid since hospital stay. I will contact my state Medicaid to obtain all medical records from hospital admittance until now.
Thank you
Brief Answer:
As detailed below.
Detailed Answer:
Hi.
Thanks you so much for detailed feedback.
Read the history and feedback carefully to correlate the signs and symptoms.
My thoughts.
- Since the pain is all over abdomen, there is more possibility of lingering peritonitis in spite of normal WBC and CT scan with unclear results.
- Further course of of an antibiotic and anti-inflammatory with painkiller properties may help as you have taken in past like Vicoprofen to be taken more regularly.
- When in doubt a second look procedure may be advised. That is re-exploration may be after a second opinion.
Second opinion of another Surgeon helps in many cases in proper diagnosis and management.
I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
As detailed below.
Detailed Answer:
Hi.
Thanks you so much for detailed feedback.
Read the history and feedback carefully to correlate the signs and symptoms.
My thoughts.
- Since the pain is all over abdomen, there is more possibility of lingering peritonitis in spite of normal WBC and CT scan with unclear results.
- Further course of of an antibiotic and anti-inflammatory with painkiller properties may help as you have taken in past like Vicoprofen to be taken more regularly.
- When in doubt a second look procedure may be advised. That is re-exploration may be after a second opinion.
Second opinion of another Surgeon helps in many cases in proper diagnosis and management.
I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that information. I thought that my current surgeon's dismissal of my pain and thoughts about the CT scan and "normal" WBC were his way of getting me out of his office. I will continue with OTC pain meds PRN, monitoring my temperature and if the pain gets worse or if I start vomiting again, I will visit the ER.
I plan to visit my PCP early next week for a GYN exam and to get referrals for preventative care (colonoscopy, mammogram and skin cancer screening), as well as a referral to another surgeon for a second opinion.
Thanks again. This puts my mind at ease and worries me at the same time, but I appreciate your input.
By the way, the surgeon thinks that the pain in my peritoneum is largely caused by constipation.....even though my bowels are working normally. I have BM's every day, one more than I had before the surgery. After 53 years, I know my body and this pain is not constipation. I eat too well for that.
I plan to visit my PCP early next week for a GYN exam and to get referrals for preventative care (colonoscopy, mammogram and skin cancer screening), as well as a referral to another surgeon for a second opinion.
Thanks again. This puts my mind at ease and worries me at the same time, but I appreciate your input.
By the way, the surgeon thinks that the pain in my peritoneum is largely caused by constipation.....even though my bowels are working normally. I have BM's every day, one more than I had before the surgery. After 53 years, I know my body and this pain is not constipation. I eat too well for that.
Brief Answer:
Please tell me the exacts symptoms and position as of today/stat.
Detailed Answer:
Sincere thanks for your appreciation and the inputs.
I do agree with you to a certain extent as me/Surgeon friends too sometimes get caught into such a situation. But then this is the situation where we have to put an extra efforts and go to the minutest details and always take a second opinion as it helps a lot.
Please try to get second opinion as early as possible.
There is a saying: if the patients appetite is normal, passes bowel normally and sleeps well, the things are progressing normally.
A plain X-ray of the abdomen in lying down and standing position gives a lot of information like intestinal obstruction gives picture of air-fluid levels, colon loaded with fecoliths can be well seen and if present an enema helps a lot for relief of symptoms.
Please tell me the exact position, the symptoms at the moment.
Please tell me the exacts symptoms and position as of today/stat.
Detailed Answer:
Sincere thanks for your appreciation and the inputs.
I do agree with you to a certain extent as me/Surgeon friends too sometimes get caught into such a situation. But then this is the situation where we have to put an extra efforts and go to the minutest details and always take a second opinion as it helps a lot.
Please try to get second opinion as early as possible.
There is a saying: if the patients appetite is normal, passes bowel normally and sleeps well, the things are progressing normally.
A plain X-ray of the abdomen in lying down and standing position gives a lot of information like intestinal obstruction gives picture of air-fluid levels, colon loaded with fecoliths can be well seen and if present an enema helps a lot for relief of symptoms.
Please tell me the exact position, the symptoms at the moment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Peritoneal pain, not urinating like usual, not hungry, excessive thirst, dissented abdomen, morning BM only, no gas passed.
Oral temp: 98.9
Anal temp: 99.4
Axillary (underarm) temp: 98.8
Oral temp: 98.9
Anal temp: 99.4
Axillary (underarm) temp: 98.8
Brief Answer:
Have one visit to ER -
Detailed Answer:
Noted your symptoms.
With these I think it would be better to have one visit to ER and get few more investigations to see if there is something that may need , may be an immediate attention - as mentioned above.
Have one visit to ER -
Detailed Answer:
Noted your symptoms.
With these I think it would be better to have one visit to ER and get few more investigations to see if there is something that may need , may be an immediate attention - as mentioned above.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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