Re: radiating pain after appendectomy

Posted By W. D. on May 06, 1999 at 10:52:07
My sister began experiencing right sided pelvic pain which didn't carry the classic symptoms of appendicitis.  After an ultra sound and a cat scan she had a colonoscopy which revealed an area of the colon which seemed to exhude some fluid.  She had the appendectomy done laparascopicaly about five weeks ago.  The doctor resected a portion of the bowel that seemed thickened along with taking out the appendix...he also cut down adhesions which had resulted from a previous ectopic pregnancy.  Two weeks after surgery my sister still had sharp right sided pain and in addition pain in her right side cheek and pain traveling to three areas of her thigh down to knee.  At first surgeon dismissed problem and told her to do stretching exercises. Pain persisted, he referred her to a neurologist. Her right leg made no movement when hit to test reflex. It is now five weeks after surgery.  Pain continues and is more intense and right leg feels a little weak.  She has had another CAT Scan and just had an MRI done.  The neurolgist said that if MRI shows nothing, he would do nothing more than put her on nerve medicine.  Is there another test that could diagnose the source of her difficulty.  She is a flight attendant with 27 year seniority who will never be able to go back to work in this shape.  

[CCF MD mdf]

Posted By CCF MD mdf on May 06, 1999 at 11:41:04
Sounds like a "pinched nerve" at the lumbosacral spine, probably around L2-3-4 given the distribution of the pain and absence of knee jerk.
The surgical exploration or instrumentation itself would not have damaged anything there. However, if your sister had degenerative spine disease (wear and tear, quite common and quite probable as a pre-existing condition), lying on the operating table may have led to compression of the nerve root at the point where it exits the spine.
An MRI of the lumbosacral spine should show whether there is much disc bulging or other sign of wear and tear. I wouldn't be a bit surprised if mild degen changes are shown, but there may not be much more than that. Occasionally you find a real herniated (not just bulging) disc and sufficient debris to be convinced of the source of compression injury.
If degenerative spine disease is extensive, she may wish to see a spine surgeon but be sure you know all your options prior to consenting to surgical decompression. In any case, physical therapy is often quite helpful. Certain medications like nortriptyline (an old antidepressant) can be very useful for chronic pain even if depression has nothing to do with the problem.
I hope this helps. As you know, this information is provided for educational purposes only. Any comment regarding diagnosis, prognosis, and treatment options must come from your physician after appropriate evaluation. CCF MD mdf.











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