Brief Answer:
Please upload reports.

Detailed Answer:
Hello,

Thanks for posting your query.

Please upload the reports since I have not received any and also please give me any relevant information you wish to have suggestions about at present.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Tuberculosis unlikely.

Detailed Answer:
Hello,

Thanks for writing back.

I have gone through all the attachments; in fact, I remember most of them from the earlier query. Tuberculosis, is unlikely in the current scenario without associated lymph node enlargement and/or adhesions.

Moreover, ultrasound is not very helpful in such an instance. As suggested in the earlier query, please go ahead with MRI for proper view. The blood counts are mostly within normal limits and the aberrations are slight and not very significant.

Hope your query has been answered. Please feel free to contact for further clarifications. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Looks like simple wound induration with possible bowel adhesions.

Detailed Answer:
Hello,

Thanks for your query.

Tuberculosis has been ruled out through investigation as well. The medication prescribed by your gynecologist is meant to relieve pain and possible surface wound infection. This can be clubbed with your anti-asthmatic medication but with some gap in between medications.

The medications given by your gynecologist are not meant for cure; they are for symptomatic relief.

Necrosis is not likely in the current scenario since the clinical picture does not suit that.

You do not seem to have any infection at all as evidenced both by the clinical picture and the investigations. The wound could perhaps have some induration as often happens after surgeries. In such instances, enzymes like serratiopeptidase and chymotrypsin often help to decrease the swelling.

The possibility of bowel adhesions should however be ruled out. Please see a surgeon for a proper assessment. Though complete obstruction is unlikely in view of the symptoms, partial obstruction is possible and this needs correction.

In the current scenario, if bowel involvement can be excluded, the best treatment would be observation, with enzymes and occasional pain killers. Tissue healing should be allowed to occur naturally by improving the general condition.

Hope your queries have been answered. Please get back if you need further help. I will be glad to do so.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hello,

Thanks for writing back.

Here are your answers:

1. Abdominal tuberculosis---diagnosis can be made through clinical findings, ultrasound, plain x-ray of the abdomen, colonoscopy and abdominal CT scan. Laparoscopy is however, the best way of diagnosis. A chest x-ray taken simultaneously can reveal pulmonary involvement.

Going by the symptoms and sonogram findings, it does not appear to be a case of abdominal tuberculosis. I am attaching a link here for you to browse through. Please concentrate on the clinical findings.

http://medind.nic.in/iby/t04/i10/ibyt04i10p305.pdf

2. Sumag ointment is a simple antibacterial ointment used to treat surface wound infections like abscesses, boils etc. This may not help in your case and I would not advise it.

Zinase D is a combination of Diclofenac, an analgesic and anti-inflammatory along with Serratiopeptidase, an enzyme which is used to help wound healing. This may be used if the pain needs management. Else, you can ask for a prescription of the enzyme alone. I would suggest the enzyme.

3. Usually, consumption of very fine particles of glass does not cause any harm and the best policy is to wait and see. Meanwhile, she should have bland diet. Yet, I would suggest a visit to your health care provider and report the matter. Endoscopy may be required if the particles need to be removed at the pyloric junction before they pass into the intestine. Usually, the bowel movements, which are gentle, generally do not cause any damage as the pieces of glass pass through to get excreted.

4. Necrotizing Fasciitis---in this condition, there is a continuous deterioration of the general condition with sepsis. Since your wife is stable and has been facing this compliant of pain ever since the surgery with no major deterioration in health, this is an unlikely possibility. I am giving a link here for you to go through.

http://www.medicinenet.com/necrotizing_fasciitis/page3.htm

The best way to diagnose is to get a culture of biopsied material obtained from the swelling. Laparoscopy is also helpful at times.

Finally, I think she is facing the common after effects of surgery and child bearing which will heal in a few months. For a better opinion, please see either a physician or surgeon who is experienced. Finally, the only alternative left to know what is wrong is either to have a laparoscopy and/or a laparotomy.

Hope I have answered all your queries. Please contact if you need any more help. I will be glad to do.

regards,
Shanti.V.

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Brief Answer:
Please improve nutrition, rest and take counselling.

Detailed Answer:
Hello,

Thanks for posting your query.

I truly can understand the agony you are facing right now. Yet, I would say all that is unnecessary. You truly have no gross pathology and hence need not worry.

Please do not go by the words of the radiologist because, clinical correlation is a must in all lab tests. The finding of hypoechoic region is mostly nothing but a healing wound. It is not tuberculosis since tuberculosis in that location is also associated with other findings as I showed you in the link I gave.

So many times, wounds heal slowly and pain persists for longer period. Healing, as you know, is dependent on the individual system and hence, can vary from person to person. The weakness is quite natural for a nursing mother after a delivery, be it abdominal or vaginal. This is due to the healing process taking place in the body and the increased need for rest and proper nourishment.

I feel CT is not necessary, but, if you wish, you can get it done. It is true that radiation is the risk, but, this investigation is recommended to clarify about the presence or absence of abdominal tuberculosis.

Your current treatment can include Zinase D, Zevit, your anti-asthmatic treatment, rabeprozole if symptoms of gastritis persist. Ointment may be used if you wish. In addition, you should improve protein intake in your diet. You can use milk powders like Proteinex and protein biscuits like Threptin. Increase intake of fresh green vegetables, fruits and liquids. If you can, eat a boiled egg everyday. Take adequate rest and also practice relaxation techniques. You can also try music therapy. Finally, I would also advise counselling sessions to tide over your anxieties.

Hope all your queries have been answered. Please feel free to contact if you need any more clarifications. I will be happy to help.

regards,
Shanti.V.

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