Right Abdominal Pain: Is Surgery Necessary for Adhesions?

Gastrointestinal bloating issues with sharp pain?

Hello Doctor, thank you for your previous response regarding my issue with binge eating and bloating.
I would like to ask you again: I often feel discomfort on the right side of my abdomen, sometimes experiencing sharp pain below my right rib cage and other times a burning sensation in the upper right abdomen.
After a particularly large dinner (about three times my usual amount) following a binge, I experienced pain in my right abdomen that night and went to see a doctor.
Could it be possible that my appendix was inflamed at that time, and later the inflammation decreased but caused adhesions in the surrounding intestines? Each time I experience bloating, I feel particularly uncomfortable in my right flank or right abdomen.
Even after getting up and using the restroom, I still feel a strange sensation in my right flank and abdomen, almost like something is there.
An X-ray indicated gastric or intestinal bloating, and a CT scan noted thickening of the intestinal wall.
I was later referred to a surgeon, who suggested laparoscopic surgery to check for possible adhesions and to see if the intestines need to be repositioned or fixed.
Do you think there is a surgical necessity for this?

Zhang Ke 0, 30~39 year old female. Ask Date: 2022/04/05

Dr. Chen Jiaming reply Surgery

I suggest you arrange for an abdominal ultrasound to check for any issues with gallstones or bile sludge.
Rapid weight loss can sometimes lead to the formation of gallstones and symptoms of biliary colic, and the timing of your symptoms makes it quite likely that further confirmation is needed.
As for surgery to check for intestinal adhesions or displacement, that is unfounded.

Reply Date: 2022/04/05

More Info

Understanding right abdominal pain, especially after previous surgeries or episodes of gastrointestinal distress, can be complex. Your symptoms, including discomfort in the right side of your abdomen, sharp pain under the right rib cage, and a burning sensation in the right upper abdomen, warrant careful consideration.
Firstly, the history of overeating and subsequent abdominal pain raises the possibility of acute gastrointestinal issues, such as appendicitis or even gallbladder-related problems, especially if you have a history of gallstones or gallbladder disease. However, since you mentioned that the inflammation was low and that imaging studies suggested gas or bloating, it is possible that your symptoms are related to functional gastrointestinal disorders rather than acute inflammatory processes.

Adhesions, which are bands of scar tissue that can form after surgery, can lead to chronic abdominal pain and discomfort. They can cause the intestines to stick together or to the abdominal wall, leading to symptoms such as pain, bloating, and changes in bowel habits. If your previous surgeries involved the abdominal cavity, the formation of adhesions is a plausible explanation for your ongoing discomfort.
The suggestion from your surgeon to consider laparoscopic surgery to explore and potentially release any adhesions is a common approach in such cases. Laparoscopy is minimally invasive and allows for direct visualization of the abdominal organs. If adhesions are found, they can often be released during the procedure, which may alleviate your symptoms. However, it is essential to weigh the risks and benefits of surgery. While laparoscopic surgery can provide relief, there is no guarantee that it will resolve all symptoms, and there is a risk of developing new adhesions post-surgery.

In terms of whether surgery is necessary, it largely depends on the severity of your symptoms and their impact on your quality of life. If your pain is persistent, significantly affecting your daily activities, and conservative management (such as dietary changes, medications for pain relief, and possibly physical therapy) has not provided relief, then surgical intervention may be justified.

Additionally, the thickening of the bowel wall noted on imaging could indicate inflammation or other underlying issues that may need further evaluation. It is crucial to discuss these findings with your healthcare provider to determine if additional diagnostic tests, such as an MRI or a colonoscopy, are warranted to rule out other conditions, such as inflammatory bowel disease or malignancy.

In summary, while laparoscopic surgery to address potential adhesions may be a reasonable option given your symptoms, it is essential to have a thorough discussion with your surgeon about the potential outcomes, risks, and alternative management strategies. Keeping a symptom diary, noting when pain occurs, its intensity, and any associated factors (like diet or activity level) can also provide valuable information for your healthcare team in making the best decision for your situation.

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