Looking for cause of post surgical pain

I have a pain that has stumped my colorectal surgeon and my gastroenterologist. I'm 6 months post laparoscopic colectomy and 4 most post takedown, so I have a Jpouch. I have chronic pouchitis and I'm managing it with cipro. I returned to work about 6 weeks ago and the first couple of weeks were great. I was eating light meals (soup, yogurt, oatmeal) and having no bathroom urgency, in fact, I was only going 3-4 times a day. But, a pain in my stomach started creeping up after eating. First it just felt like I was very full, even if I just ate a small amount. Then it felt more like a gas pain, sharp shooting pains, usually radiating up my left shoulder. Now it's progressed to the point that eating anything, even drinking liquids, causes this pain. Now here's the weird part. It's completely or almost completely alleviated by lying down flat on my back. If I try to roll on my stomach or side, I get some sharp pains, but they're temporary. If I stand or sit up, it's continuous (at varying degrees) for hours. I'm to the point where I'm just working half days on an empty stomach, but that is getting too exhausting and I may need to take another complete medical leave. I'm desperate to figure out what is causing this. My gastroenterologist speculated GERD or a stomach ulcer (albeit a strange presentation, as GERD usually get worse when lying down, not better), but two weeks of protonix did not help, in fact my condition worsened. My surgeon speculated scar tissue, but didn't have a diagnosis test for that or really any solution if that was the case. What else could it be and what else can I try?

Amy,

I'd try to treat the pouchitis a little more aggressively for 2 weeks to see if it helps. When I'm having issues then I combine Cipro and Augmentin, it works pretty well for my pouchitis.

Maybe you want to get an MRI to see if you have any adhesions causing you issues. When your stomach gets larger from food then it could be pushing on an adhesion which is causing you the problem...just speculating.

I have the same pain you have. But I know what mine is and it's abdominal hernias. The pain can usually be alleviated if I lay flat. Not always, but most of the time.

amybanks said...
Thanks. Both great ideas. I started a two week course of Flagyl in addition to the Cipro and it helped almost immediately with some of my lower abdominal discomfort. So at least I know how to get the pouchitis under control. The other issue is the same. I had a contrast upper GI X-ray and they found no evidence of reflux and just mild distention of my small bowel. I'm not sure what's next. I can no longer work because of the pain. Thanks.

Amy,

Antibiotics lose their effectiveness over time, you need to rotate them and take breaks/vacations. I'd start trying other antibiotics like Xifaxan.

I find Pepto Bismol capsules to be very helpful. They are almost as effective as antibiotics, great for when you are not doing to well or you are taking a vacation from the antibiotics.

And be on the lookout for Thrush, that can happen if you are on an antibiotic for too long. Both Cipro and Flagyl give me Thrush after a few weeks.

Amy,

Sounds like you are having insurance issues, if you have a chance to switch then I'd recommend it. I switched from an HMO to a PPO and it's made it much easier to find doctors who take my plan. Personally for me it is worth the extra cost, my healthcare costs a lot and there are less insurance headaches/restrictions with the PPO.

I wanted to post an update for anyone who stumbles upon this post and to thank Keith for the advice. I ended up getting an MRI, X-ray follow thru, endoscopy, and pouchoscopy. They found that my duodenum coming out of my stomach got misplaced from my colectomy surgery. They described it as turning the direction of a backwards C when it's supposed to be a forward C. So a rare, strange complication. Good news is there is no blockage and in the months now that I've been dealing with it, it's slowly resolving itself. I can know usually eat without pain, and the few times I do have pain, laying down for a couple minutes helps. As for the pouchitis, it's under pretty good control. Cipro started giving me tendonitis in my Achilles, so I'm just doing Flagyl. I've weened down to just two tablets a week, and I take daily probiotics. So things are looking up for me!

I take pepto bismol tablets regularly, it acts like a mild antibiotic with very few side effects. Many Jpouchers use it regularly.

Amy, I happy that you are feeling better.