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Suggest treatment for peritonitis, blocked bowel, pain and tightness

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Posted on Mon, 29 Jun 2015
Question: 66 year-old male. No history of abdominal problems until I had abdominal surgery about 15 months ago -- blocked bowel. My excruciating pain began on a Saturday afternoon and I went into surgery the following Tuesday. What started as a laparoscopic procedure changed to a large-incision abdominal procedure after the surgeon (in his words) "nicked" my intestine. The intestine was, evidently, in pretty bad shape and the "nick" and leaking bowel caused peritonitis -- I was in the hospital for 18 days. I recovered okay. At this point, I'm not really limited in terms of physical activity. However, there is "tightness" and, sometimes, pain in the abdomen, both lower and around my waist. I'm afraid adhesions have developed. My questions is: with what specialist should I seek a diagnosis and counseling? Should I seek a gastroenterologist or a surgeon? I also need to ask questions about standards of care.











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Answered by Dr. Grzegorz Stanko (14 minutes later)
Brief Answer:
Surgeon is the correct address.

Detailed Answer:
Hello!

Thank you for the query.

You definitely should consult a surgeon (specialized in gastrointestinal surgeries). The point is that both gastroenterologist and your family physician are a type of theoretic doctors. They really do not know how the abdomen looks like inside so theirs point of view is very limited.

Saying that there is no way to diagnose adhesions they are significantly missing the truth. We have tools to do that.
First of all, there should be done colonoscopy. Secondly CT enteroclysis or MRI enterography (both can answer if there is any narrowing in the small intestine). And finally laparoscopy (yes, this is also a diagnostic tool) can give an answer about how advanced are the adhesions and if the intestines are widen above the obstacle and narrow below it.

As you have had perforation, adhesions are more than guaranteed at your case. Intestinal fluid simply causes major inflammation in the abdominal cavity what greatly stimulates the adhesions. Even without perforation, some adhesions do appear. The point is to determine if any of this adhesions do impede the stool passage.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5769 Questions

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Suggest treatment for peritonitis, blocked bowel, pain and tightness

Brief Answer: Surgeon is the correct address. Detailed Answer: Hello! Thank you for the query. You definitely should consult a surgeon (specialized in gastrointestinal surgeries). The point is that both gastroenterologist and your family physician are a type of theoretic doctors. They really do not know how the abdomen looks like inside so theirs point of view is very limited. Saying that there is no way to diagnose adhesions they are significantly missing the truth. We have tools to do that. First of all, there should be done colonoscopy. Secondly CT enteroclysis or MRI enterography (both can answer if there is any narrowing in the small intestine). And finally laparoscopy (yes, this is also a diagnostic tool) can give an answer about how advanced are the adhesions and if the intestines are widen above the obstacle and narrow below it. As you have had perforation, adhesions are more than guaranteed at your case. Intestinal fluid simply causes major inflammation in the abdominal cavity what greatly stimulates the adhesions. Even without perforation, some adhesions do appear. The point is to determine if any of this adhesions do impede the stool passage. Hope this will help. Feel free to ask further questions. Regards.