Is a Second Appendectomy Necessary? Recurrent Abdominal Pain

Is it possible to have had an appendectomy twice?

Hello doctor, I experienced abdominal pain in April and went to the emergency department at China Medical University Hospital, where I underwent an appendectomy.
However, in May, I had abdominal pain again and visited the emergency department.
The emergency physician performed an ultrasound and X-ray, stating that there was no inflammation at the surgical site and suspected that the pain was due to excessive fecal matter.
After that, I paid attention to my diet and bowel movements.
Unfortunately, in June, I experienced severe abdominal pain again and went to a different hospital.
Blood tests, ultrasound, and X-ray showed elevated white blood cell count and some dehydration, leading to a suspicion of gastroenteritis (the doctor noted that pressing on my lower right abdomen caused significant pain and suggested that if it happened again, I should return to China Medical University Hospital).
After taking medication, I returned for a follow-up a week later, and my white blood cell count was normal, leading me to believe it was over...
In July, which is recent, I experienced abdominal pain again and returned to the emergency department at China Medical University Hospital.
They performed the same ultrasound, X-ray, and blood tests, all indicating that I was fine...
Therefore, I requested a CT scan, and the results showed appendicitis (why was the blood test normal despite the inflammation? The surgical resident said he was puzzled...).
Since the surgeon who performed my operation was not on duty, I returned for a follow-up a week later, and they said that my appendix is shaped differently from others, and there is still a segment (about 1 cm) remaining inside...
My question is, is a second surgery necessary? Could the repeated abdominal pain be due to the remaining appendix? Is this situation reasonable? It is truly beyond my understanding.
😢😢😢😢

AK, 30~39 year old female. Ask Date: 2020/07/20

Dr. Yu Mingchang reply Surgery

None.

Reply Date: 2020/07/20

More Info

The situation you are describing is indeed complex and requires careful consideration. After undergoing an appendectomy, it is not uncommon for patients to experience recurrent abdominal pain, which can lead to confusion regarding the need for a second surgery.
First, let's address the possibility of a second appendectomy. In your case, it appears that despite the initial surgery, there remains a small portion of the appendix that was not removed. This can happen in some cases, particularly if the appendix is not easily accessible or if the surgeon is unable to visualize the entire structure during the procedure. The presence of residual appendiceal tissue can potentially lead to recurrent symptoms, including abdominal pain, especially if that tissue becomes inflamed or infected.

Your recurrent abdominal pain, especially if it is localized to the right lower quadrant, raises the suspicion of appendicitis or complications related to the previous surgery. However, it is also important to consider other potential causes of abdominal pain, such as bowel obstructions, adhesions from previous surgeries, or gastrointestinal issues like irritable bowel syndrome or inflammatory bowel disease. The fact that your blood tests have shown normal white blood cell counts during some episodes suggests that there may not always be an acute inflammatory process occurring, but it does not rule out the possibility of chronic issues.

Regarding your question about whether a second surgery is necessary, this decision should be made collaboratively with your healthcare provider. If imaging studies, such as a CT scan, have confirmed the presence of residual appendiceal tissue and you are experiencing significant symptoms that affect your quality of life, a second appendectomy may be warranted. It is essential to weigh the risks and benefits of another surgical intervention, especially considering your previous experiences and the potential for complications.

Additionally, it is crucial to explore non-surgical options that may help alleviate your symptoms. Dietary modifications, increased hydration, and regular bowel habits can help manage symptoms related to constipation or gastrointestinal discomfort. If your pain is related to bowel function, working with a gastroenterologist may provide insights into managing your symptoms without the need for further surgery.

In summary, while a second appendectomy may be necessary if there is clear evidence of residual appendiceal tissue causing your symptoms, it is essential to consider all potential causes of your recurrent abdominal pain. A thorough evaluation by your healthcare provider, including imaging studies and possibly consultations with specialists, will help determine the best course of action. Open communication with your medical team about your symptoms and concerns is vital in making an informed decision regarding your treatment options.

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