Post-Appendectomy Concerns: Gas, Nausea, and Wound Issues

Acute appendicitis and localized peritonitis?

Hello doctor, my wife underwent laparoscopic appendectomy on September 14th.
It has been a week since the surgery, and she is still experiencing some issues, so I have a few questions:
1.
On the first day after the surgery, she only drank water and juice, but the doctor said it was okay to drink even though she hadn't passed gas yet.
However, she only passed gas the next day, and her abdomen is still feeling bloated.
As of today, September 21st, she continues to experience discomfort from the bloating.
The doctor prescribed pain medication, medication for bloating, and antibiotics, but her condition remains the same.
Is this normal?
2.
Since returning home, she has only been eating plain rice porridge, and her condition hasn't improved.
Tonight, she drank an additional bowl of chicken soup and then started vomiting.
Is this normal?
3.
Since returning home after the surgery, I have noticed a hard lump about the size of a fingertip above her belly button incision, which has started to become red since yesterday.
What does this indicate?

Houzi Awei, 30~39 year old female. Ask Date: 2018/09/21

Dr. Xu Kaixi reply Surgery

1.
The patient underwent laparoscopic appendectomy on September 14.
On September 21, they experienced bloating and poor digestion, and were taking pain medication, experiencing gastric distension, and antibiotics.
This may be due to a postoperative inflammatory response that has not fully resolved.
A light diet with small, frequent meals is recommended for a few days, and theoretically, the condition will gradually improve.

2.
Chicken soup is relatively greasy and may be difficult to digest, potentially leading to indigestion and vomiting.

3.
Redness around the incision may be due to pigmentation deposition from scarring or infection; a visit to the outpatient clinic is necessary to examine the wound for confirmation.

Reply Date: 2018/09/21

More Info

Post-appendectomy concerns, such as gas, nausea, and wound issues, are common and can be distressing for both the patient and their family. Let's address your questions one by one.

1. Persistent Gas and Bloating: After laparoscopic appendectomy, it is not uncommon for patients to experience bloating and gas. This can be attributed to several factors, including the use of carbon dioxide gas during the procedure to inflate the abdomen, which can take time to be absorbed and expelled. Additionally, the digestive system may be sluggish post-surgery due to anesthesia and the body's natural healing process. It is important to follow your doctor's advice regarding diet and medications. If your wife is still experiencing significant discomfort after a week, it may be worth discussing with her healthcare provider. They might suggest gentle abdominal massage, walking, or specific over-the-counter medications to help relieve gas.

2. Nausea and Vomiting After Eating: Nausea and vomiting can occur after surgery, especially if the diet is advanced too quickly or if the stomach is still sensitive. Since your wife has been on a bland diet (like rice porridge), it should generally be well-tolerated. However, introducing new foods, such as chicken soup, should be done gradually. If she vomits after eating, it could be due to several reasons, including the body's reaction to anesthesia, dietary changes, or even anxiety about eating post-surgery. If nausea persists, it’s essential to consult her doctor, who may prescribe anti-nausea medication or recommend dietary adjustments.

3. Wound Concerns: The presence of a hard lump near the navel incision, especially if it has become red, warrants attention. This could indicate several things, including a hematoma (a localized collection of blood outside of blood vessels), seroma (a pocket of clear fluid), or even an infection. Signs of infection include increased redness, warmth, swelling, and discharge from the incision site. It is crucial to monitor these symptoms closely. If the lump continues to grow, becomes increasingly painful, or if there are signs of infection, your wife should see her healthcare provider as soon as possible for evaluation.

In summary, while some discomfort and symptoms are normal after an appendectomy, persistent issues like significant bloating, nausea, and changes in the wound should not be ignored. It is always best to err on the side of caution and consult with her healthcare provider to ensure that her recovery is on track and to rule out any complications. Recovery can vary significantly from person to person, and open communication with her medical team is key to addressing any concerns effectively.

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