Post-Surgery Concerns After Gastric Perforation: Your Questions Answered

Postoperative issues following gastric perforation surgery?

Hello Dr.
Hong, I would like to consult you on the following issues.
Thank you.
Summary of the condition: I maintain a normal lifestyle, do not smoke or drink, and do not stay up late.
However, recently I took medication for two weeks due to sinusitis (the doctor did not prescribe any gastric medication).
Additionally, due to high work stress, I experienced severe stomach pain on the morning of November 12.
After a CT scan in the emergency room, it was determined that I might have a gastric perforation.
I was hospitalized for surgery on November 12 and discharged on November 19, totaling 8 days in the hospital.
The perforation was located at the junction of the duodenum and stomach, approximately 0.33 cm, and tests confirmed it was only an inflammatory issue.
The abdominal incision was about 10 cm (likely traditional surgery).
My recovery has been good, and I have adhered to the proper diet and lifestyle.
The only medication prescribed by the doctor is Pantoprazole 40 mg, to be taken once daily after breakfast for three months.
Questions:
1.
I previously experienced stomach issues, mainly postprandial bloating, but on the day of the perforation, the pain occurred in the early morning (around 7 AM).
However, even several days post-surgery until today, I still experience some stomach pain around the same time each morning.
Is there a specific issue causing this? Why is it so regular? Should I be particularly cautious or return to the hospital for further examination?

2.
On the morning of December 5, I suddenly developed a low-grade fever of around 37.8°C, which increased to 38.5°C by 6 PM.
After taking a dose of acetaminophen, I slept and returned to normal the next morning.
My appetite remained normal, but due to discomfort from the fever, I ate about 30% less.
Additionally, I usually have a bowel movement after breakfast (this routine has been consistent since my discharge), but on December 5, I did not have a bowel movement until the evening of December 6, despite having flatulence.
Could this be related to gastrointestinal adhesions, or is there another reason?
3.
Can I take pineapple enzyme or probiotics? A friend gave me a bottle of Wei Jie capsules, which are said to be good for the stomach, but I am unsure if they will interact with Pantoprazole.
Is it safe to take them?
4.
I have read the instructions for Pantoprazole, which state it should not be taken for more than 8 weeks, but my doctor prescribed it for three months.
Is it okay to take it for three months, or can I decide to stop after two months based on my condition?

Hu, 30~39 year old female. Ask Date: 2022/12/06

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
Due to endocrine factors, along with the fact that it is quieter at night, most pain tends to be more pronounced during the night; this is a physiological phenomenon.
If there is a sudden severe pain, then it is necessary to seek medical attention.

2.
Yes, surgery can indeed cause some degree of intestinal adhesions; however, if you are able to pass gas, it indicates that you are still able to expel gas.

3.
These medications will not interact with Pantoprazole, but it is advisable to consult your surgeon before using them.

4.
Three months is acceptable; regarding whether it is appropriate to discontinue medication, it is recommended to follow up with your surgeon, as this should be determined based on your overall physical condition.
Thank you for your inquiry.

Reply Date: 2022/12/06

More Info

Post-surgery concerns, especially after a significant event like gastric perforation, can be quite complex and concerning. Let's address your questions one by one, while also providing some additional context regarding your situation.

1. Morning Gastric Pain: It is not uncommon for patients who have undergone surgery for gastric perforation to experience some degree of discomfort or pain, particularly in the early mornings. This could be attributed to several factors, including the healing process, changes in gastric motility, or even the timing of your medication. The fact that you are experiencing this pain regularly in the morning may suggest that your stomach is reacting to the empty state it is in after a night of fasting. If the pain is mild and subsides after eating, it may not be a cause for alarm. However, if the pain intensifies or is accompanied by other symptoms such as nausea, vomiting, or changes in bowel habits, it would be prudent to consult your healthcare provider for further evaluation.

2. Fever and Bowel Movements: The low-grade fever you experienced could be a response to inflammation or infection, especially considering your recent surgery. It is important to monitor any fever closely. The absence of bowel movements, despite the presence of gas, could indicate a temporary slowdown in bowel function, which can occur post-surgery due to factors like anesthesia, pain medications, or even stress. While adhesions (scar tissue) can cause bowel obstruction, the fact that you are passing gas is a good sign that your intestines are still functioning. If you continue to have difficulty with bowel movements or experience significant abdominal pain, it would be wise to seek medical advice.

3. Dietary Supplements: Regarding the consumption of pineapple enzymes or probiotics, these are generally considered safe for most individuals. However, given your recent surgery and ongoing medication (Pantoprazole), it is essential to consult your healthcare provider before introducing any new supplements. Pantoprazole is a proton pump inhibitor that reduces stomach acid, and while it does not typically interact with these supplements, individual responses can vary. Always check with your doctor to ensure that any new supplement will not interfere with your recovery or existing medications.

4. Duration of Pantoprazole Use: Pantoprazole is often prescribed for a longer duration in cases of significant gastric issues, including post-surgical recovery. While the label may suggest a maximum of 8 weeks, your physician has determined that a 3-month course is appropriate for your situation. It is crucial to follow your doctor's recommendations, as they are based on your specific health needs. After two months, you should have a follow-up appointment to assess your condition and determine whether it is appropriate to continue or adjust your medication.

In summary, your post-surgery symptoms are not uncommon, but they do warrant careful monitoring. It is essential to maintain open communication with your healthcare team, especially if you notice any changes in your symptoms or if new concerns arise. Your recovery is a process, and being proactive about your health will help ensure the best outcomes. Always prioritize follow-up appointments and do not hesitate to reach out to your healthcare provider with any questions or concerns.

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