What causes pain at the site of colon removal and hernia repair?

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Posted on Mon, 1 Dec 2014 in Abdominal Pain
Question: I'm back. My provider, who only prescribed meds, scared me into surgery, which caused infection and internal mess, did not once ask for tests - so, I am without a doctor and, am afraid, since I am by far worse than before, what I can do next. I ask you this - the area where colon was removed has pain and, it feels like something gets stuck, but, since I choose to take myself away from those who were careless, questions won't help. But, you have offered great advice, and, if someone would take time to look at the area in the side of rectum where mesh attaches to inside and I get the pain and restriction, how would they look - I had an injection -
ganglion impair which made me feel like i was having an out of body experience - pain, anger, emotional; then, for one day I had relief, but the pressure was still in rectal area and the pain returned the next day. One day of relief was surreal and I saw the person I once was, but, it only lasted one day and that same pressure which restricts my leg was apparent.
Any clues on this or is it confusing. Thank you, kind sir.
doctor
Answered by Dr. Ajit Naniksingh Kukreja 3 hours later
Brief Answer:
Means the pain is of nerve origin

Detailed Answer:
Hi XXXXXXX

You are welcome anytime

What was the surgery your health care provider advised ?

We are always there so please do not feel left out, there could be some communication gap but the doctors are always there for the patients, luckily we are those God gifted people who can help you relieve the agony

Your information has given me a clue, Ganglion impair has pointed to my presumption that the pain is of nerve origin

But the medication used usually a steroid and local anesthetic agent, is not working in you

As advised in my last mail I would suggest you start Gabapentine along with Methylcobalamin twice a day for minimum of six weeks and take Tramadol for instant pain relief

Please give this a trial and am confident it will surely help
Do not hesitate to write back again

Wishing you a very healthy life ahead
Regards



Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja 11 hours later
All I have is time on my hands to think this through. So, more questions. Why couldn't I empty after taking 8 laxatives and drank liquid prior to colonoscopy? During colonoscopy, he had to push very hard to get the scope through and the nurse had to push on my stomach while he pushed, to get scope through. Eventually it went through, but it was tough. So, he considered no blockage. However, it takes up to two weeks to have a BM and I can literally feel the Matter coming down, staying in place and eventually passing. The passing in the resection is where the nerves fire and is also where the pressure is that starts the pain in the rectum I call "toothache" pain - nerves fired up so much it takes a couple of days to settle. It wasn't until after the hernia repair that I had increased pain and the function of bowel movement became harder and harder. This I reported to someone covering for doctor who was absent during most of time but nurse didn't do anything. I do have pain at the area where colon was removed and in several areas around the mesh used for hernia repair - pricking; nothing substantial, but, it is as if staples are poking me. I know you will say to have certain tests, but it doesn't work this way here. The bureaucracy of the military; not accepting that nobody did anything but drugs and, all the tests in the world do no good if my provider didn't know that she was to send them off. Unfortunately, she was in over her head, but, because doctor's words are heard and a patient is ignored, here I am, giving up the fight. It's known that the surgeon who did the colorectal surgery pulled healthy colon; left me with wet bandages which started infection. The pulling and tugging at resection restricts my leg and, if I were to not walk, I would not have pain in the rectum area except when a bowel passes through. I have a tens unit, but I am raw from using it. During the course of time, there was no follow through except my husband and I did our best to find an answer to pain so, of course, pain management, decides to d injections. The last pain management doctor who did the ganglion impar injection was very thoughtful and cautious; he said it was diagnostic. He also said, any more injections would be a bandaid and more risky. Point is, from the very beginning, rather than take my issues seriously, I was given meds and now, because of failures, my brain has given up.
I know exactly where I have pain; I know meds can't help with gastro pain and I also know that it was wrong not to have CT scans and MRI's read and the right doctors allowed to see because provider didn't know to do this. The mesh is so close to my sternum, it is miserable to wear anything around that area. Can you see that after so long, one would just give up? We have a case in the US where the Veteran's Administration fired their top dog - a very fine man; a friend of ours, and, I believe, in the military hospital, things are going on like this. When I asked to see another doctor because I knew, in beginning, the one I was seeing was not paying attention (later fired) and two others were fired, it shows that I didn't have a chance from day one - and then to be scared into this colorectal surgery which has caused so much pain, and for the Powers that be not know all the facts, which could get help for me, is absurd. Why would I keep going back only for disappointment. In all this, do you see the questions about colonoscopy (coiled transverse) and more gastro problems after hernia repair. I can't take any more so, unless a miracle happens, I can't go to another doctor and try to explain because there are deaf ears. Thank you.
doctor
Answered by Dr. Ajit Naniksingh Kukreja 1 hour later
Brief Answer:
Reassure yourself

Detailed Answer:
Hi XXXXXXX

It was like going through a script of a movie with a sad end

But I always see light at the other end of the tunnel

Yes ganglion impair is not for day to day use, it is diagnostic most of the times, but have seen patients who respond well in the first instance for them it is therapeutic

Have a very good friend of mine who practices pain management and is a master in this field - in Algonquin, IL, United States, If you need I can talk to him to see you personally

For your bowel movements, do you mean to say you pass stool every two weeks ?

No I will not advice any more tests, I can understand the agony of bowel movements, mesh, pelvic pain etc

Let us start managing them in a phase wise manner

As advised go for Gabapentin 600mg with Methylcobalamin twice a day for minimum of six weeks

For acute episodes of pain take tramadol 50 mg

Add a good probiotic twice a day and Tab Lubiprostone 24 mg twice a day

Not to complicate we will take a trial of these and discuss the results as and when need be

Hope this convinces you
Regards
Do keep me posted about the effectiveness of my management
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja 22 days later
Thank you. May I explain clearly that the area at colon removal site and hernia repair is very painful; the surgeon did not do a CT scan for either so I have nothing to compare.
He is, literally, running from practice to practice, and his initial office said, because of legal reasons, they could not talk to me; my records have disappeared into thin air. Knowing how badly he failed, it's important to think of the pain in the rectum where he attached two strips of mesh to the side of rectum; I feel like if a few staples could be removed, I'd have no pain and free of leg restriction - layman's terms.
I am on a good diet so am having frequent movements, but, my stomach rests on area of hernia repair so intake of food is small portions; that's ok, but it is also causing me to take short breaths. The worst, however, and I'll put this in the form of a question - the colonoscopy was torture; my ribs were sore and since, I have such pain; cramping; and extreme movement; basically, a couch potato. Just telling you this I realize how bizarre it sounds, but, having been lost in the cracks; treated by a doctor who still had chronic pain from rear ending on her mind; gave drugs, no tests for symptoms in rectum or under mesh (entire abdominal area) so, you see, not having good follow thru has made things worse. The ganglion impar took pain for one day but the restriction of movement in that area was noticeable. If you have contacts in the United States where I could get a full assessment wi/o back pain the only consideration, my husband and I will go. I need a doctor or doctors who will listen, believe me, put heads together and understand I have worked so hard at getting better to the extent I had to demand getting off opiates. Months and months with no guidance and, the doctor who gave the ganglion impair injection said anything else is more risky and made it clear that it's only a bandaid as he knew I hadn't been listened to or followed in areas of two surgeries. In closing, my daughter came over tonight and said "Mom, God doesn't want you like this; you're too important and have too much to give, so if I have to pick you up and take you to the right
doctor/s or clinic, I will." She knows the lack of attention; the awful results of the unnecessary colorectal surgery and she knows me. But, it's a crazy story, isn't it. Thank you for recommending your friend. I'd go to Anarctica but, my intestines are on fire. Is it appropriate to try to see into the small intestines? I had colonoscopies before the surgery and not a problem. I would think just not being able to clean out would be a red flag, but, I have time to worry. Nothing can take away the pain - I have a tens unit near rectum because i can deal with "gut" and rectum. You understand he cut the colon; sealed it then opened a hole in the side of the rectum and used two strips of mesh to secure it. I believe strongly that a staple or staples or impinging. What do you think and thank you. I'm glad I found you again.
doctor
Answered by Dr. Ajit Naniksingh Kukreja 9 hours later
Brief Answer:
Need to reassure yourself first

Detailed Answer:
Hi XXXXXXX

I had been to a workshop for a live surgery as a faculty so could not attend your direct question on Saturday

So I wrote to the moderators and requested them to direct your queries to me irrespective of the reimbursement being provided to the one who answers your query
They were good enough to send the link to you

Coming to the issue
I can understand the agony, as I had suggested earlier a contrast follow through study of the entire GI tract may be along with a contrast CT of the abdomen will be more informative than any thing else

Again to mention about ganglion impair it has served its purpose of diagnosis, that the pain is probably of neurologic origin

An expert in pain management would help you better so if convenient see the doctor I suggested

Have you tried the medicines I had recommended earlier ?
Have they worked or there is no response ?

Stapplers can not cause issues on their own except if a nerve twig is entangled within during anastomosis or during mesh fixation

Hope I have cleared your confusion to some extent
Am always available my response may be delayed if am in a workshop

Wishing you a healthy life ahead
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja 1 hour later
The stables are embedded. I can only say that the pain woke me up very early (near resection) off Percocet . The epidural was in area surgeon closed colon. But, pain is definitely at connection side. My back is raw from using tens. Then, the brain goes to pain at colon removal and transverse colon. My diet has improved the issue of constipation but, I am confident for a long time this was ready to give. Colostomy was brutal and intestines on fire. I cannot go back to Military because they didn't get past pain from accident. Also, only help was drugs. If I walk, pulling at rectum hence pain and leg restriction to protect. Wearing tens only emphasizes the abdomen. My sternum is painful; so close to mesh and stomach rests on skin above mesh. The dr didn't say if he wanted me back. I know nobody wants to mess w/me so I 'm without care now. They drew up withdrawal plan and don't check how I'm doing. Pain literally has me afraid to walk and this is not good. I'm too young! I'm paying for mistake and negligence but, in XXXXXXX the dr gets away w/this. What happens to poor soul who can't afford to go elsewhere or just takes a drs word? I am going to help those types one day.
doctor
Answered by Dr. Ajit Naniksingh Kukreja 3 hours later
Brief Answer:
A good noble initiative to help the suffering

Detailed Answer:
Hi

Tens is again pointing to a neurological origin
I would still emphasize you take Gabapentine and Methylcobalamine for a long time say a minimum of six weeks and let me know if it works

I totally sympathize with your situation so I would suggest instead of discussing on what wrong was done by whom we should concentrate on how we can increase your comfort level

Also when convenient get the contrast enhanced CT and follow through study done and get back to me

Epidural can be of help in pain management Do not understand how it caused issues to you

Do write back in case you have any doubts
Get Well Soon
Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja 27 minutes later
Tens is used to distract; I tried Gabapentin and couldn't take it; This pain is so much like staples embedded.
You are right; stop the blame game; now I'm petrified to go to a dr. And sitting here is so foreign. I will get tests done - but, another colonoscopy is frightening and, since I have pain at colon removal sight and many areas under mesh what type of test for that. I'm sorry. I fired my doctor and feel lost. Military is great but too busy. A nurse is coming by to check my vitals as pain in sternum area which is right at the ridge of mesh.
I understand your point about the tens, but, it's kind of a pain that distracts me from the pain I have and it is worse than having a baby. You're a good man.
I have the tens right where the resection was done at the rectum. You're the doctor. I just want a life. Since I can't take Gabapentin - it's been so long, but I had terrible depression and no results.
There's such a thing as not checking new symptoms. After the two surgeries, I was still labeled chronic pain patient and nothing was done for the side effects of surgeries; that's just as much my fault - it didn't even XXXXXXX on me. But, you are wise; my husband says the same thing, but, now, it's where do I go? Not your problem to answer. Have a good day.
What is so extraordinary about staples being entrapped? This is exactly what it feels like. Walking aggravates it and I can feel the pull. This has to be the most bizarre case you've ever heard. I hear myself telling about the four years and it's hard to believe. But, I could at leas dn. My guts are so bad, I'm couch bound. And petrified. Sorry. It's been so much and who do you trust? Take care.
doctor
Answered by Dr. Ajit Naniksingh Kukreja 19 minutes later
Brief Answer:
Again Reassure yourself, Thanks for kind words

Detailed Answer:
Hi

Trust the Almighty
There is a way to every issue

Not to talk about myself, but if you recollect I have undergone four major procedures with infections, grafting and what not and that too as a XXXXXXX surgeon myself, 33 months away from work and non weight bearing

But I was determined to get out of it
Yes my medical knowledge did play a role in it
But we are always there for patients like you

Treating a regular patient day in and day out is never a challenge, it is once in a life time that you get a typical case where in you like to put in all your resources

Philosophy aside, I would wait for the reports if you get them done during a comfortable period

Instead of Gabapentin, try pregabalin it has the same effect
Tens works like a counter irritant for you so you may discontinue the same

And do not blame yourself, this will drag you in to deeper depression, instead start Yoga and meditation, may be it may work

Would eagerly wait for the day when you send me a mail with some relief from this unusual pain

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Ajit Naniksingh Kukreja

Gastroenterologist, Surgical

Practicing since :1984

Answered : 923 Questions

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