Post-Appendectomy Recovery: Pain and Elevated White Blood Cell Count

Post-appendectomy

Hello Dr.
Hsu, I am from Hong Kong.
After my examination on January 30, the doctor informed me that I had appendicitis and a rupture, with contaminated fluid in my abdomen.
I was also told that I had colitis, and I underwent surgery at 3 PM that same day.
After the surgery, I had a drainage tube inserted in my abdomen and a urinary catheter.
By February 1, I finally passed gas and was able to consume porridge.
On February 3, all the tubes were removed.
On the first day post-surgery, I had to continuously clean the wound since it had not yet been sutured.
I reviewed my blood test results from after the surgery, which indicated that my white blood cell count remained elevated, initially at 19, and was 17.9 the day before discharge.
The doctor examined me but could not determine the cause of the elevated white blood cell count.
On the day of discharge, another blood test was conducted, but I did not see the report; however, the nurse and doctor reviewed it and said my white blood cell count had decreased, allowing me to be discharged.
After the surgery, I did not have a bowel movement, only passing gas.
It wasn't until February 8 and 9 that I had a bowel movement.
However, after returning home and eating meat, I experienced hard stools, taking two hours to pass.
This continued, so I avoided pork and chicken, only eating fish, vegetables, and rice, which I could digest.
Eventually, I visited the outpatient clinic and received medication that improved my condition, but I still avoided difficult-to-digest foods.
On March 28, I went to a laboratory to check my white blood cell count and found that, although it was lower than during my hospital stay, it was still above the normal range.
The blood test report showed a WBC count of 11.15, with the differential count indicating neutrophils at 67.3%, lymphocytes at 24.3%, monocytes at 6.8%, eosinophils at 1.3%, and basophils at 0.3%.
The absolute counts were neutrophils at 7.5, lymphocytes at 2.71, monocytes at 0.76, eosinophils at 0.15, and basophils at 0.03.
Recently, I have noticed something strange with my abdomen.
The wound has healed but has developed red granulation tissue, and I still experience pain.
The area around the drainage site is also painful, and there is discomfort above my navel, though it is not constant.
The pain near the wound is triggered by touch, and prolonged walking causes discomfort.
I also experience sudden abdominal pain above the navel, but the pain is not severe, rated at a level 3.
Although my white blood cell count has not returned to normal since the surgery, I do not have a fever; I just feel weaker and more sensitive to cold.
I have been concerned that the internal wound may not have healed completely and could be infected.
I have searched online for explanations, and most sources indicate that inflammation could cause these symptoms.
However, I found one source that suggested that after major surgery, white blood cell counts can remain elevated.
The day before the doctor sutured my wound, she mentioned that a CT scan showed fluid in my abdomen, but she said the body would absorb it naturally.
Is that true? Could this fluid be causing inflammation in my abdomen, preventing my white blood cell count from returning to normal? If I had peritonitis, I would expect significant pain and fever.
This issue worries me, especially since a friend who had surgery for a uterine fibroid on February 9 has completely healed without pain, while I still experience discomfort.
I also recall that on February 27, there was purulent drainage and granulation tissue near my navel, and bacteria were found in the pus.
However, after the doctor prescribed antibiotics and I had the granulation tissue removed and cleaned the wound for several days, the inflammation resolved.
I hope you can clarify why, after a month and a half post-surgery, my wound is still painful and my white blood cell count has not returned to normal.
Thank you, doctor!

Yu Yan, 30~39 year old female. Ask Date: 2014/04/01

Dr. Xu Kaixi reply Surgery

Based on the information you provided, the initial diagnosis of appendicitis and rupture, along with the surgical approach and postoperative care and recovery process, combined with ongoing gastrointestinal symptoms, wound pain, and a series of blood test results, indicate that your appendicitis was a more severe infection requiring a longer recovery time.
Therefore, the phenomena of wound pain, poor digestion, and elevated white blood cell count persisting for half a month post-surgery are considered acceptable.
However, if these conditions continue to persist or worsen, it is essential to rule out the possibility of other complications or abnormalities within the abdominal cavity, including intra-abdominal abscesses.
It is recommended that you seek a personal consultation for further evaluation to determine the necessity of additional examinations, such as a CT scan.

Reply Date: 2014/04/01

More Info

Post-appendectomy recovery can be a complex process, especially when complications arise such as elevated white blood cell (WBC) counts and persistent pain. Your situation, involving an appendectomy due to appendicitis and subsequent complications, raises several important points regarding recovery and the body's response to surgery.

Firstly, it is not uncommon for patients to experience elevated WBC counts after surgery. This is often a physiological response to stress, inflammation, or infection. In your case, the initial WBC count of 19, which later decreased to 17.9, indicates that your body was likely responding to the surgical trauma and any underlying infection from the appendicitis. A normal WBC count typically ranges from 4,500 to 11,000 cells per microliter of blood. Your count of 11.15, while still above the normal range, suggests that your body is still in the process of healing.

The presence of abdominal pain, particularly around the surgical site, is also a common experience during recovery. Pain can be attributed to several factors, including the healing of tissues, the presence of scar tissue, and even the irritation of nerves in the area. The fact that you are experiencing pain when touching the area or after prolonged activity is not unusual. However, if the pain is significant or worsening, it is essential to consult your healthcare provider.

Regarding the drainage tube and the presence of fluid in the abdomen (abdominal effusion), it is possible for the body to absorb this fluid naturally over time. However, if the fluid is infected or if there are signs of ongoing inflammation, this could contribute to elevated WBC counts and persistent discomfort. The fact that you had pus and bacteria detected in the fluid suggests that there may have been an infection that required antibiotic treatment, which seems to have helped resolve the immediate issue.

Your concerns about the healing process and the comparison to your friend's recovery are valid. Each person's healing journey is unique, influenced by factors such as the extent of the surgery, individual health status, and any complications that may arise. While some patients may heal quickly and experience minimal pain, others may take longer and have more discomfort.
It is also important to consider your diet during recovery. Hard stools can be a common issue post-surgery, especially if you are hesitant to eat certain foods. A diet rich in fiber, hydration, and possibly the use of stool softeners can help alleviate constipation and improve bowel movements.
In summary, while elevated WBC counts and pain can be concerning, they are not uncommon following an appendectomy, especially with complications. It is crucial to maintain open communication with your healthcare provider about your symptoms, any changes in your condition, and your recovery progress. If you experience new symptoms, increased pain, or signs of infection (such as fever), seek medical attention promptly. Your recovery is a process, and with appropriate care and monitoring, you should continue to improve.

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