Year After Appendectomy: Ongoing Discomfort and Distension
I'm a 54-year-old woman, slightly overweight but generally in good health, and in a post-menopausal state while undergoing hormone replacement therapy. About 15 years ago, I underwent a lower body lift after shedding over 100 pounds. In April 2024, I experienced an emergency laparoscopic appendectomy. Right after the operation, I felt a peculiar tugging sensation beneath my left ribs, akin to invisible strings pulling towards my belly button, located away from any surgical sites. When I consulted with my surgeon, he indicated that my recovery had been particularly challenging and it might be attributed to strained muscles due to coughing. So, I decided to disregard it at the time. However, the pulling sensation persisted and was coupled with significant bloating. Initially, I attributed this discomfort to powerful antibiotics I had ingested before the procedure. To address my bloating, I increased my intake of fermented foods and maintained a high fiber diet, but there were no improvements. I attempted to monitor my diet closely, hoping to identify any contributors to the bloating, which I increasingly suspected was related to the rib discomfort, yet I could not pinpoint any specific triggers. Fast forward to October 2024, the discomfort escalated. I undertook a challenging two-week camping expedition with my husband through eastern Arizona, where we minimized contact with other people while living out of a tent. While these self-sustaining wilderness experiences bring me joy, they are also physically demanding. As the trip progressed, the more physically active I became, the more my abdominal distension grew, eventually to the point where I lost my appetite. Since late October, I have shed 25 pounds, primarily before February when I managed to stabilize my weight. In November, I consulted my doctor regarding the persistent rib tugging, and she speculated it could be related to my spleen. Blood tests revealed slightly elevated red blood cell counts and hematocrit, which remain unchanged. A CT scan indicated a small amount of free fluid in my pelvis, but all other organs appeared to be normal according to both CT scans and X-rays. A subsequent pelvic ultrasound confirmed the presence of free fluid, which my primary care physician dismissed as non-concerning. Being nearly a decade post-menopausal, she concluded it was irritable bowel syndrome (IBS), despite my lack of typical IBS symptoms beyond this localized distension. I do not experience any constipation, diarrhea, excessive gas, cramps, belching, or distress after eating. The bloating was unaffected by a meticulously followed FODMAP diet for five weeks, nor did it respond to simethicone or similar treatments. Out of options, I placed my hopes in a gastrointestinal (GI) specialist I saw in January. The GI doctor recommended an esophagogastroduodenoscopy (EGD) and a colonoscopy, along with suggesting another FODMAP diet trial. All tests returned normal results, and I didn’t notice any changes while on the FODMAP regimen. Additionally, I tried three fasting periods of varying lengths—one lasting 24 hours and two extending to 36 hours—without any alterations to my bloating or discomfort. My condition has only continued to deteriorate, yet I am unable to discuss my test results directly with the GI doctor until June. Throughout this period of tracking my symptoms, I have come to realize that lying down alleviates the discomfort, which has now turned into occasional pain. Standing or sitting, even for a brief period, induces discomfort and causes noticeable swelling in my abdomen on the left side, between my ribs and belly button. This sensation is followed by a downward pull on my ribs that becomes increasingly painful, alongside the growing abdominal distension. It feels as if air is trapped within my abdomen, outside of my digestive tract. Is it conceivable for this to happen a year after my surgery? The onset of these symptoms correlates directly with my appendectomy experience. I am confident this is not IBS. Any insights would be greatly appreciated!
Answers (1)
3/24/2025, 8:01:19 PM
OpenHealth AI
I'm sorry to hear about the ongoing discomfort and challenges you're facing since your appendectomy. These symptoms can be concerning and I'm here to help you navigate this situation.
Key Points:
- You are experiencing persistent abdominal discomfort and distension after surgery.
- Your symptoms have not responded to dietary changes or treatments typically used for gastrointestinal issues.
- Lying down alleviates your discomfort, but standing or sitting worsens it.
Explanation:
After an appendectomy, it's not uncommon to experience changes in abdominal sensations, especially if recovery has been complicated by factors like muscle strain or previous weight loss surgery. The tugging sensation you described and the bloating could be related to factors such as:
- Post-surgical adhesions: Scar tissue can form after surgery and may cause discomfort or change how organs move.
- Muscle strain: Since you've participated in physically demanding activities, your abdominal muscles may be strained beyond normal recovery.
Your CT scan indicating free fluid, while previously considered non-concerning, should still be monitored as it could be related to post-surgical changes.
Next Steps:
-
Continue Symptom Monitoring: Keep a detailed diary of your symptoms, noting what activities worsen or relieve your discomfort. Include your diet, activity level, and symptom intensity.
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Gentle Exercises and Mobility: Since standing or sitting exacerbates your pain, try gentle stretching or mobility exercises. Avoid heavy lifting or strenuous activities until you can discuss your symptoms and any potential impacts with your GI doctor.
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Consider Physical Therapy: If available, a physical therapist with experience in post-surgical recovery could provide guidance tailored to your situation and help with core strengthening exercises without aggravating your symptoms.
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Pain Management: Discuss non-invasive pain relief options with your doctor, such as heating pads or gentle pain relief medications, to help manage intermittent pain.
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Follow Up with Your GI Specialist: While you wait for your appointment in June, ensure you express the need for a timely follow-up if your symptoms worsen or significantly change. Persistent discomfort warrants clear communication with your healthcare providers.
Keep persisting in seeking answers. Abdominal symptoms following surgery can be complex, but with your detailed observations and follow-up with doctors, you can find a path to relief. If your symptoms escalate to severe pain, significant changes in weight, or any new alarming signs, seek urgent medical advice promptly.
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