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Had laparoscopy and hysteroscopy for stage 2 endometriosis. Having severe pain. Cause? Second opinion?

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Hello. I had my second laparoscopy and hysteroscopy 3 weeks ago, for stage 2 endometriosis, and adenomyosis. This time, they also needed to remove my appendix because of the endo on it. I'm 20 years old. After the first surgery, I had no post op complications, but this time feels very different. I'm having waves of SEVERE pain on my lower right side. It's a very sharp, stabbing pain so severe that when it comes, it brings me to tears and I can't move a muscle until it passes. My surgeon (an endo specialist for 17 years) believes that it's the stitches from where my appendix used to be, poking into my abdominal wall. I have no fever or signs of infection. My concern is that after 3 weeks, I feel like the stitches would have mostly dissolved by now, or at least softened so that they wouldn't be causing me this much pain anymore. Should I get a second opinion, or give it more time? The pain is really crippling when it comes.

I should also mention that my surgeon performed a pre-sacral neurectomy to help with the adenomyosis pain. Thank you!
Posted Sat, 27 Jul 2013 in General Health
Answered by Dr. Grzegorz Stanko 45 minutes later

Thank you for the query.

There is no way for stitches to cause such symptoms. No way. Stitches itself are usually neutral for the human body. Sometimes it irritates the tissues what can cause an inflammation in the stitches area. But it would rather cause a constant pain than the pain described by you. It is possible for the stitches to cause chronic pain in the surgery area. It can be caused by intestine stitched into the abdominal wall or nerve caught by some stitches. But in the appendix area, there is no such nerves. Moreover, such pain is constant as the stitches are constantly in the same place.

Waves of pain, especially the strong one, are quite characteristic for obstructed intestines. Intestine muscles work just like a wave so the stool can go forward. When there is an obstacle, this muscle work causes such waves of pain. Some call it cramping. This is more probable if your abdomen get bloated, gas gets obstructed, nausea appears.

You need to know that every surgery leaves some adhesions in the abdominal cavity. Moreover endometriosis is a great source of such adhesions. Due to adhesions intestines can get narrow what leads to an obstruction. So it makes you prone to this disease and it should be ruled out at first (instead of stitches problem).

I suggest you to get second opinion as you have mentioned. You should have good physical examination, abdominal X-ray at first. If no findings, abdominal CT with oral contrast (enteroclysis) should be done at first.

Hope this will help. Feel free to ask further questions.
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Follow-up: Had laparoscopy and hysteroscopy for stage 2 endometriosis. Having severe pain. Cause? Second opinion? 1 hour later
Thank you so much for your response. I was wondering about that as a possibility, as the pain seems to happen most often when I have a bowel movement coming. When I asked my surgeon about that, he said it was unlikely because typically intestinal pain from constipation is typically centralized or on the left, and he sort of blew off the question because my pain is always on the lower right hand side. In terms of a second opinion, who do you think I should see? A primary care, my OBGYN, or a gastrointestinal specialist?
I also want to mention that due to the endo/adeno pain, I have also been diagnosed with pelvic floor dysfunction/pelvic muscle spasms. I am scheduled to start seeing a pelvic physical therapist. Do you think maybe that could be the cause of the pain, or do you think it's definitely a bowel obstruction? I know there's no way for you to truly know since you can't do a real exam for me, but I'd appreciate if you could give me some feedback on that as well.
Thank you again!
Answered by Dr. Grzegorz Stanko 48 minutes later
Bowel obstruction pain is usually localized on the left side if the obstruction is in the large intestine. Small intestine obstruction (which is more often caused by adhesions than large intestine obstruction) ca give pain in any location. As there was some part of intestine removed(appendix) in the pain area, small intestine obstruction due to adhesions post this removal should be considered.
I`m not sure if this is an obstruction. But I`m completely certain that this should be ruled at at first.

spasm would give the pain lower than appendix is located. The pain would be sensed more around the groin or peritoneum than in the scar area. But this is possible source of the pain, especially muscle spasm. Such pain can appear and disappear spontaneously. However the pain would be unrelated to bowel movement, abdomen would not become bloated.

I suggest you to visit gastroenterologist or general surgeon at first. Mentioned tests should be done.
If you feel like there might be muscle spasm problem causing your symptoms, please try Magnesium and Potassium supplementation and see if this helps. Muscle pain will get less intense with Diclophenac for example. Bowels pain should get better with muscles relaxing pain killers (like Buscolisyne or Metamizole).

Hope this will help.
Above answer was peer-reviewed by
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