Post-Surgery Concerns: Adhesions, Inflammation, and Menstrual Changes

Discharged from June 26 to July 5. Diagnosis: 1. Intestinal Adhesions, 2. Pelvic Inflammatory Disease, 3. Acute Appendicitis?

Hello Dr.
Chen, I hope you are well this winter.
On June 24, I experienced mild abdominal pain, which escalated to severe pain around midnight on the 25th.
I went to the emergency department at Keelung Chang Gung Memorial Hospital around 11 PM.
I was left outside the emergency room receiving IV fluids until after 11 AM on the 26th, when a female physician finally called me inside.
Within a few minutes, they removed the intrauterine device (IUD) that I had had for six years.
They only asked me questions verbally and did not use any instruments to examine me for over ten hours, despite my repeated complaints of pain.
After the IUD removal, I was still given IV fluids, but I felt it was ineffective and I continued to be in pain.
I communicated this to the medical staff, but no one responded.
I requested to have the IV removed, and since no one attended to my request, I removed the needle myself and left.
Around 1 PM, I registered for a consultation at Keelung City Xin Kunming Hospital, where the doctor quickly diagnosed me with appendicitis.
I was then referred to the emergency department of Keelung City Government Hospital for surgery, which was scheduled about an hour later.
I stayed in the hospital for 10 days before being discharged.
The discharge diagnosis included: 1) intestinal adhesions, 2) pelvic inflammatory disease, and 3) acute appendicitis.
The length of my scar is 20 cm, with the widest part measuring 0.8 cm.
I have two questions.
First, I feel that the delay at Chang Gung Hospital from the night of the 25th to 1 PM on the 26th cost me over ten hours.
They ultimately did not even identify my condition, and I left after removing the IV myself.
I find it hard to imagine what my outcome would have been if I had continued receiving IV fluids there, and thinking about it frightens me.
Additionally, if I had been diagnosed and scheduled for surgery sooner during those hours, my postoperative scar might not be this large.
Am I wrong to think this way?
Second, I would like to ask about my menstrual cycle.
I was discharged on July 5, and now, five months later, I have not had a period.
I had a cesarean section 20 years ago and have had uterine cysts; I am now 43 years old.
Is it abnormal for me not to have menstruated during this time? Should I schedule an appointment with a gynecologist for an examination, or should I just let it be?

Chen Wei, 40~49 year old female. Ask Date: 2021/12/06

Dr. Chen Jiaming reply Surgery

Medical clinical diagnoses must be based on actual evidence for judgment.
From the fact that the initial medical facility specifically requested assistance from an obstetrician-gynecologist to remove an intrauterine device, it can be inferred that their diagnosis leaned towards pelvic inflammatory disease.
Their administration of intravenous fluids and antibiotic treatment was appropriate given the diagnosis.
As for the subsequent two facilities that diagnosed you with appendicitis and proceeded with surgery, the long abdominal incision indicates that there was significant intestinal adhesion present, as described in the diagnosis.
The presence of intestinal adhesions is not typically caused by appendicitis within a day or two; it is usually the result of prior intra-abdominal infections or chronic pelvic inflammatory disease.
Therefore, your assumption is incorrect.
When experiencing pain, many subjective feelings may not be accurate; perhaps you were not fully attentive to the medical explanations provided by the first facility.
Regarding your menstrual concerns, it is advisable to consult an obstetrician-gynecologist for further examination.
Generally, after surgeries involving severe intra-abdominal infections, patients may occasionally experience delayed menstruation, but it is still recommended to seek further evaluation from a gynecologist.
I hope this explanation is helpful to you.

Reply Date: 2021/12/06

More Info

Hello, and thank you for sharing your concerns regarding your recent medical experiences. It sounds like you've been through quite a challenging time, and I appreciate your detailed account of your situation. Let’s address your questions one by one.

1. Delays in Diagnosis and Treatment
You mentioned feeling that the delay in your diagnosis at Chang Gung Memorial Hospital contributed to your current condition, including the size of your surgical scar. It’s understandable to feel anxious about the potential consequences of a delay in treatment, especially when experiencing severe pain. In emergency medicine, timely diagnosis and intervention are crucial, particularly in cases like appendicitis, where a delay can lead to complications such as perforation or peritonitis.

While it’s difficult to speculate on what might have happened had you received prompt treatment, your feelings are valid. If you believe that your care was inadequate, it may be worth discussing this with a healthcare professional or a patient advocate. They can help you understand your rights and options regarding your care and any potential recourse for the experience you had.

2. Menstrual Changes Post-Surgery
Regarding your menstrual cycle, it’s not uncommon for women to experience changes in their menstrual patterns after undergoing abdominal surgery, especially if there was significant inflammation or if the surgery involved the pelvic area. The conditions you were diagnosed with—adhesions and pelvic inflammatory disease—can affect the reproductive organs and may lead to changes in menstrual cycles.

Given that you have not had a menstrual period since your surgery in July, it would be prudent to consult with a gynecologist. Factors such as hormonal changes, stress from your medical experiences, and the physical impact of surgery can all contribute to changes in your menstrual cycle. Additionally, since you have a history of uterine cysts and are now 43 years old, it’s important to rule out any other underlying issues, such as hormonal imbalances or complications related to your previous conditions.

Recommendations
1. Follow-Up with a Gynecologist: I recommend scheduling an appointment with a gynecologist to discuss your lack of menstruation. They may perform a physical examination, ultrasound, or blood tests to assess your hormonal levels and overall reproductive health.

2. Monitor Your Symptoms: Keep track of any other symptoms you may experience, such as abdominal pain, changes in weight, or emotional changes, as these can provide valuable information to your healthcare provider.

3. Consider Counseling: Given the distressing nature of your recent medical experiences, you might also benefit from speaking with a mental health professional. They can help you process your feelings about your care and the impact it has had on your well-being.

4. Stay Informed: Continue to educate yourself about your health conditions and treatment options. Being informed can empower you to make the best decisions for your health moving forward.

In conclusion, it’s essential to address both your physical and emotional health following such significant medical events. Seeking appropriate follow-up care and support will be crucial in your recovery process. Thank you for sharing your story, and I wish you the best in your journey toward healing.

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