Recurrent abdominal pain after CHOLECYSTECTOMY, ADHESIONOLYSIS after APPENDICECTOMY.

Resolved Question:

Dear All,
Please see the medical report below and give us your opinions, suggestions such medication or surgery ... how to ease the patient abdominal pain and thrombosis and to help her to lead normal living.
Many Thanks

Patient name: Yassmin
Sex: Female
Old: 36 yeas
Patient Nationality: Egyptian
Marital status: married and have one child 12.5 years old patientold
Occupation: Housewife

• Female patient named Yassmin was pregnant after marriage at 16-7-2002 and after delivery there was postpartum hemorrhage followed by deep vein thrombosis at day 7 starting at aortic bifurcation
• The patient complaint from menorrhagia and diagnosed to be endometriosis via diagnostic laparoscopy and electro cauterization of these points of endometriosis was done followed by medical treatment for 8 months.
• The menstruation stopped for 3 months after stopping treatment and the patient received primarin tab up to 16 tab /day for 1 year and stopped due to the hormonal changes.
• The patient diagnosed to be helicobacter pylori infection (abdominal pains diarrhea vomiting for more than 1 month ) by endoscopy and after trial of medical treatment the patient started complaining from constipation and abdominal pain and diagnosed as adhesive intestinal obstruction post appendectomy (since 17 years old patient). adhesiolysis was done with improvement .
• Patient was readmitted after short time with the same complaint; colonoscopy was done with no results
• The decision was to do partial colectomy .
• Partial colectomy was done and there was one motion every 4 days , postoperatively and gradually increased to one motion /18 days.
• Patient underwent MRI defecography and colonic transit time and rectal inertia was diagnosed.
• Levatorplasty was done with partial improvement followed by deteriorations.
• Re exploration for total colectomy was done and Proceed mesh inserted. post operative, there was wattery diarrhea followed by obstruction again .
• Another operation for proctectomy and ileoanal anastmosis .
• Postoperatively there was severe abdominal pain and at 1-11-2011 the patient readmitted with fecal fistula (multiple opening of anterior abdominal wall)
• Exploration and removal of the mesh and resection of part of small intestine and another mesh inserted (biologic) followed by fecal fistula again With amount (150 to 500 ml) , meanwhile there was deep vein thrombosis again
• Patient readmitted to Arab Contractor Hospital at 25-3-2012 with total parenteral nutrition course for 5 weeks , and trial of fibrin glue injection with no result .
• 6 months later ,exploration was done and adhesiolysis with closure of the fistulae of small bowel with improvement of the general condition.
• Laparoscopic cholecystectomy was done 1 year later
• Nowdays the patient complains from recurrent severe abdominal pains
• Evacuation done only with oral adiminstration of 200cc mannitol 20%


Category: Gastroenterologist, Surgical

Ask Your Own Question

Category: Gastroenterologist, Surgical
Dr. Lokesh HM is online now

Expert:  Dr. Lokesh HM replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
As the patient underwent multiple complicated surgeries in the past patient is having abdominal pain due to adhesive colic.
With past history of constipation due to colon and rectal inertia she may be having problem with her small bowel also, that's why she is having constipation.
She cat take tab. Lesuride 25mg bd x5 days.
Liquid paraffin 30ml in the night.
Let her take the medicine for 5 days, and let me know if she is feeling better.
Feel free to discuss further.


Patient replied :

Patient has been taken medications to improve her constipation & it didn't help, is there any other suggestion such surgery .... That you might think of. Many Thanks.


Expert:  Dr. Lokesh HM replied 3 Days.

No surgery would help. ..because already full colon and rectum has been removed. Now it looks like pouch dysfunction causing her constipation.
Removing ileal pouch may help. ..but she has to be on permanent ileostomy.
This will relieve her constipation permanently.

Thanks


Dr. Lokesh HM
Category: Gastroenterologist, Surgical
Experience: 
Fellowship: Minimal Access Surgery (FMAS)
Fellowship: Pancreato-Biliary surgery (FPBS), SGPGI Lucknow, 2012
Senior Residency: MCh, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI) Lucknow, 2011
Junior Residency: MS, PGIMER, Chandigarh, 2008
Medical School: MBBS, MS from Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, 2007
Dr. Lokesh HM and 4 other Medical Specialists are ready to help you

Make informed and better medical decisions.

We believe that getting medical questions answered and getting qualified opinions from certified Doctors should be easier.



Specialists from
UK, US, Ind,
Aus & NZ


48000+ consults
in 2015


98.1% Satisfied
users


MEDNET Board,
100% Satisfaction
guarantee

How it works


  • Submit question, upload files, if any
  • Consult is assigned to a specialist
  • Doctor replies, Mean response time: 2 hours
  • Intimation by email, ask follow-ups

Recommendations based on

About DoctorSpring.com

Doctor Spring is a novel online Doctor consultation platform where you can get your medical questions answered by leading Doctors. Just Submit your question and rest assured that you will consult a Doctor easily. Once you submit the question, the Doctor from the concerned specialty will reply within hours. You can always ask more questions or add details with follow-up question options and make it an online doctor chat. You may use this service to consult a specialty or for getting medical second opinion. All paid services come with a MEDNET quality assurance and 100% money back guarantee.

DoctorSpring in News

News

Make informed and better medical decisions.