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APPENDIX and HERNIA surgery complicated by ENDMETRIOSIS.

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I decided to come here to see if anyone has any other input. I will try to give as much info as I can.
I am a healthy 26 year old female. Starting about 3 years ago my navel was bulging s little bit with sporadic dull pain. The best way I can explain it is a "pulling" I tight sensation in my navel area.
It was thought to be a hernia. It stopped for about a year and then last year seemed to "act up" a lot. Almost exactly a year ago (last Nov) I went to the ER with abdominal pain (not related to the navel pain I had before) and it was determined my appendix was enlarged and I went in for emergency surgery that day for that. When consulting with the surgeon before we discussed my navel since hed have to go in there anyway and he said he should be able to fix the hernia also. Two for one!
Came out of surger with success and a quick consult the next day while still at hospital the surgeon stated it appears I may have endometriosis and to consult with my regular gyno about that. This didn't surprise me as I have always had issues since being a teen with my cycles, bad cramping, etc. He stated the "hernia" did look like it had torn and some endometrial tissue had made its way they and basically tried to heal around it which is why he thinks it maybe didn't seem like a traditional hernia going on and out, etc.
A week later (the morning I was supposed to go into the surgeons for my week follow up) I woke up that morning at 5am to go to the bathroom and my belly button (where my incision was) gushed blood. It gushed out some that was dark and then was done. Like it was just some blood hanging out in there and maybe pressure for urinatinf released it. I panicked and called and surgeons office wasn't open yet and they told me to go thru ER again (since they were general surgeon thru the ER/hospital) so a surgeon from that group met me and said it appeared to just be a build up of some sort and since my incision wasn't completely healed yet it had a way out. No more
Blood came and everything basically healed up fine.
Moving forward, I have had that tight navel pain every so often still. Not bad, and belly button is not
Bulging or anything. I met with a gyno that specialized in endometriosis in March and she talked to me more about it and managing it etc and how basically they can go back on and take scar tissue out again etc and surgery wasn't recomended again so soon after my appendectomy nor was it necessary she didn't think so we did the normal talk about birth control and managing it like normal. It seems my navel pain (it's a dull pain) seems to only happy for the most part during my menstrual cycle so I have just assumed it has to do with the endometriosis. But also. There is a slight bruising in my navel that is recurring. It comes and goes. Sometimes with the pain sometimes without. This is the biggest thing that concerns me as that doesn't seem normal. Any thoughts on this or suggested tests I could ask for to make sure everything is ok?
My general doctor basically seems clueless about it. He suggested talking to the surgeon to see if they had more info and they basically don't and had told me to Do any further follow up with my general dr (I'm assuming maybe because it was done thru ER?). My general doctor honestly doesn't have much to say about it or suggestions at this point and he said he hasn't seen anything like it really.
I have blood work done once a year at my annual checkups and all of that always comes back perfectly normal.
Thanks for any input- it is much appreciated.


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
Before elaborating on your insightful query and offering an opinion, I have a quick question.
Prior to the appendix surgery, have you had any surgeries ?
I need to know this before i can advise you further,
Please write back.
Regards.


Patient replied :

No, my appendix was my first/only surgery I have had. Also, incase I didn't include it originally and incase it matters, it was done laparoscopically. Also incase any of these are factors (since they are questions doctors always ask) I am 5'3, 150 lbs. exercise regularly, drink alcohol occasionally and I am not/haven't ever been a smoker.


Expert:  Dr. Aarti Vazirani replied 3 Days.

Hello,

Thanks for writing to us with your health concern.
I think it is clear what the condition is.
You always had endometriosis - that is, endometriotic deposits outside of the uterus.
These could involve the peritoneum, the lining of the abdomen just under the skin and muscle of the abdomen.
That would explain your discomfort and and pain over the navel, alongwith a slight hernia too, that could have been there.
Now what has happened is a distinct entity called scar endometriosis.
The laparoscopic appendix surgery was done via the umbilicus ( navel ) and the residual complication is scar endometriosis, as endometriotic tissue has now invaded the scar.
That explains the pent up blood collection that happened post operatively too, since endometriotic tissue is very vascular.
Now it has healed, but it is still endometriotic tissue, so it causes monthly cyclical pain.
The clincher is the fact that you have periodic bruising too, mostly coinciding with the monthly pain.
That is typical of endometriosis, just like the uterine tissue becomes vascular and bleeds each month, this ectopic endometriotic tissue does the same.
Treatment options ?
1. Do nothing - if the pain and bruising is bearable, the birth control keeps it under check.
2. Excise it - get that area removed, and have the diagnosis confirmed with a biopsy that will confirm that the tissue is endometriotic. Can be easily done by an experienced surgeon.
3. If pain is unbearable, take hormonal therapy for the endometriotic tissue .
4. Get an MRI done anyway, it is excellent for diagnosis of endometriosis.
Hope my answer helped you.
Feel free to discuss further.
Regards.


Patient replied :

Thank you. That is an excellent and thorough answer and exactly what i was looking for as far as advice! It kind of goes along with some of my own research I have done on the matter over the last 6 months. Very helpful. My biggest worry was if the bruising was a sign of a complication. I plan to see a new doctor in March when I am due for my usual checkups and I wanted to be prepared with some possible talking points to have with the new doctor and I may request an MRI too just for peace of mind/verification purposes.
At this point being the bruising is minor and pain isnt dabilitating or anything like that I hope to just keep it managed.
I am going to close this out - thanks again - very helpful!



Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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