Post-Appendectomy Pain: Is It Adhesions?

It is common to experience pain after an appendectomy?

In mid-July, I underwent laparoscopic surgery for a perforated appendicitis complicated by a localized abscess and peritonitis, involving three ports and one drainage tube, totaling four incisions.
I had no significant issues for two months post-surgery.
However, two months later, after lifting a heavy object, I began experiencing persistent sharp pain in my lower right abdomen.
I returned for a follow-up, and the doctor prescribed anti-inflammatory and analgesic medications, but my condition fluctuates; sometimes I feel no pain, while at other times the pain returns.
An abdominal ultrasound showed no issues.
The doctor only prescribed medications to promote gastrointestinal motility and relieve bloating, without providing a clear diagnosis.
When I inquired about the possibility of adhesions, the doctor simply replied that it might be the case.
I still feel pain in the area of my appendix and nearby.
Standing or walking tends to alleviate the pain, but lying on my left side or changing positions can trigger a dull ache, similar to the pain experienced when running right after eating.
Could this be due to intestinal adhesions? What kind of pain is associated with adhesions? What further examinations can I undergo? It has been four and a half months since my surgery.
Thank you.

Youzi, 40~49 year old female. Ask Date: 2020/11/26

Dr. Chen Jiaming reply Surgery

Appendicitis with perforation and localized peritonitis will inevitably lead to some degree of intra-abdominal adhesions, which will not be altered by your surgical approach (laparoscopy).
Individuals may experience varying symptoms based on the extent of intra-abdominal adhesions; mild cases may present with decreased bowel motility, increased susceptibility to colicky pain, and bloating, while severe cases can lead to adhesive bowel obstruction (abdominal distension and vomiting).
Generally, bowel obstruction (persistent abdominal distension, pain, and vomiting) requires prompt medical attention.
For colicky pain, it is often recommended to reduce the intake of gas-producing foods and to maintain regular bowel movements (through dietary/lifestyle adjustments or medication).
Additionally, oral analgesics, such as acetaminophen, can be used during frequently occurring episodes based on individual circumstances (for example, if pain is exacerbated by turning in bed while sleeping, taking a dose before bedtime may alleviate symptoms and improve sleep quality).

Reply Date: 2020/11/26

More Info

Post-appendectomy pain can be a complex issue, especially when it persists long after the surgery. In your case, it seems that you are experiencing ongoing discomfort in the right lower abdomen following an appendectomy due to a perforated appendix and subsequent complications. This situation raises several important considerations regarding the nature of your pain and potential underlying causes.

Firstly, it is possible that your symptoms could be related to adhesions. Adhesions are bands of scar tissue that can form after surgery, connecting organs or tissues that are normally separate. They can develop as a natural part of the healing process, especially after abdominal surgeries like an appendectomy. Symptoms of adhesions can vary widely; some individuals may experience no symptoms at all, while others may have chronic pain, bowel obstruction, or changes in bowel habits. The pain associated with adhesions can often be described as cramping or pulling, and it may worsen with certain movements or positions, which aligns with your experience of pain when lying on your left side or changing positions.

The fact that your pain is intermittent and sometimes alleviated by certain positions suggests that it could indeed be related to the mechanics of your abdomen and how your organs are interacting post-surgery. Additionally, the description of your pain as similar to the discomfort felt after eating and then running could indicate that your gastrointestinal system is still adjusting after the surgery, and this could be compounded by the presence of adhesions.

In terms of further evaluation, if your symptoms persist or worsen, it may be beneficial to consider additional imaging studies. While an abdominal ultrasound is a good first step, it may not always detect adhesions. A CT scan of the abdomen and pelvis can provide more detailed information about the internal structures and may help identify any complications such as bowel obstructions or significant adhesions.
Moreover, if adhesions are confirmed or strongly suspected, treatment options may include physical therapy focused on abdominal and pelvic floor rehabilitation, which can sometimes help alleviate pain associated with adhesions. In more severe cases, surgical intervention may be necessary to remove the adhesions, but this is typically considered only after conservative measures have been exhausted.

It's also worth noting that your symptoms could be influenced by other factors, such as gastrointestinal issues unrelated to the surgery, including irritable bowel syndrome (IBS) or functional dyspepsia. These conditions can also cause abdominal pain and discomfort, and they may require different management strategies.

In conclusion, while adhesions are a plausible cause of your ongoing pain post-appendectomy, it is essential to continue working closely with your healthcare provider to explore all potential causes. Keeping a detailed record of your symptoms, including when they occur and any associated activities or dietary changes, can be helpful in guiding your healthcare team toward a more accurate diagnosis and effective treatment plan. If your current physician is not providing satisfactory answers or solutions, seeking a second opinion, particularly from a specialist in gastrointestinal disorders or a pain management specialist, may also be beneficial.

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