Well, the swelling of the abdomen and especially the vomiting is a sure-fire sign your daughter has peritonitis, which can be a complication of appendectomy. In her case, this peritonitis is when an infection from the appendicitis has developed and spread following surgery. At this point, the surgeon MUST IMMEDIATELY drain the infected abdominal fluids, drain the abscess that developed, then disinfect the abdominal cavity, and give antibiotics. Probably what happened in the first place is, when they were operating on the appendix, they switched from laprascopic surgery to open surgery for the appendicitis because they had likely come across a burst appendix, which that lets bacteria spread into the abdominal cavity. The surgeon tries his best to clear all this up, but apparently in your daughter's case, the bacteria is still there and it is most definitely spreading. This is a common complication of any surgery, but especially when you're dealing with a badly infected appendicitis. The problem with all this inadequate or nontreatment of her probable peritonitis is the bacteria that is making her abdomen swell can eventually go throughout the body and create life-threatening sepsis.
I cannot believe how two physicians now have totally overlooked peritonitis as the very likely complication of their appendectomy. I cannot tell from your post, if once they found out she was abscessed, if they did a second surgery on her as I've described she needs, but they should have. If this hospital and these docs just want to keep throwing antibiotics at her, and have not drained the abscess or the abdominal bacteria, and have not disinfected the abdominal cavity, that WILL NOT DO. She must, instead, be taken on an emergency basis to a larger hospital ER, even if you have to travel, so that sepsis can be avoided. But hopefully if you will bring up the possibility of peritonitis with a threat of sepsis to these docs or a THIRD doc there, a lightbulb will go off in their heads. You can even ask them if they did the second surgery and procedures to clear up the post-appendectomy infection and abscess that I described that they should have done. Let us know what happens.
Thank you for your response.
They opened a portion of her surgical cut in the er that night. They then paced it with gauze and has been having daily packing changes. The antibiotics they were pumping her full of face her restless leg syndrome so they were recently changed.
She is still in the hospital and still nauseas. They have a gastro dr assigned to her now. He's ordered a new ct scan and ultrasound. When he examined her he felt something on her right side that wasn't on her left. Not sure what that's about. He also said he was taking her off the antibiotics. This I find crazy! She still has open wound and packing. He seemed focused on her kidneys. I will no more when he visits.
This is all just SO wrong. I mean, far be it from me to contradict a physician who has given up so many years in study to be of help to our world. It's just that it's so obvious to me, and the literature says it so clearly, that whenever there is swelling of the abdomen, not only from an appendicitis, which she definitely had becuz she developed an absess post-appendectomy, AND there is vomiting with swelling, that means peritonitis, which if those hospital characters down there don't clean up this infection FORTHWITH, your daughter is at high risk of developing deadly sepsis.
I appreciate the feedback on what they did about the abscess that was found when she came back to the hospital post-appendectomy. Now, the removal of the abscess and wound bandage changing is not enough. When they dealt with the abscess, they also needed to DRAIN the for-sure fluids that have collected in her abdomen AND they needed to DISINFECT the abdominal cavity, and then they should have put her in the ICU for 24-hr monitoring of her temperature, swelling, and signs of sepsis. When infection is allowed to progress, it is one of the most common and also most significant complications of surgery, especially on an appendix's infection that spread to the point of abscess post-appendectomy! Swelling and vomiting equals peritonitis, and your daughter has not gotten ONE BIT BETTER during this whole hospital saga. Antibiotics alone cannot fight an infection that has spread throughout the abdominal cavity. And to TOP IT ALL OFF, this newer gastro doc has now FELT SOMETHING NEW on her right side!
I would be VERY interested in hearing what the scan shows that was just ordered, perhaps the docs will listen to the radiologist when he will surely SEE the fluids expanding her abdomen, which any of your doctors could SEE RIGHT NOW if they would just look at her. And heaven knows what other infective process has happened for the newer doc to feel something new on the same side as the appendix was. Does this doc not know your daughter had an appendectomy just two weeks ago, followed by an abscess at the wound site that required a second surgery, now coupled with a NEW finding by this very doc of something wrong in the same vicinity? I mean, after the second surgery to clear up the abscess, I'm assuming her abdominal swelling has continued. You did say her vomiting has continued, so I assumed she is also still swollen. Correct me if I'm wrong, becuz that might change the diagnosis.
Do me a favor, next time the gastro doc comes in her room, would you please be brave and mention to them politely, "Don't you think she has peritonitis? Isn't that why her abdomen is swelling and she is vomiting? What if she develops sepsis from the infection?" Memorize those questions and ask them all in one sequence, if you need to and if you want to know those answers.
Your daughter is not one bit better, she should NOT be vomiting, her abdomen should NOT be swelling. They had best have a very good answer to your three questions. And if the scan report and pictures don't show any fluids in her abdomen, then I'd sure as heck ask them what IS causing her abdomen to swell! But I do think the scan SHOULD show how come it's swollen (if it still is...let us know).
If this goes on much longer, you really do need to get a second opinion, you can get a relative or good friend down there with you to do this, either by going straight to the head of the gastroenterology department there (just wander around until you find his office since I think this is an emergency situation), or by going to another hospital ER.
If anybody else here at the gastro forum is reading this and you have ANY idea what might be going on, PLEASE, feel free to jump in. This woman and her daughter need help, and I don't care if it's different from me, because I am not a physician, I am not an expert, but I know SOMETHING about postop infections. See, maybe I've missed a clue, so please, others here, jump right on in!
Ammowoman, I agree with Ggreg, the situation you're describing is very worrisome. Since your daughter seems to be of legal age, please ask for her permission to allow the doc to speak with you about her condition. Then ask to sit and talk with the gastro doc to find out the rationale of why he's taking her off the antibiotics, his thoughts on what is going on and what the course of treatment is going to be.
In addition, if are celiac and your daughter was never tested - although she may never have shown symptoms - it's possible that it could be a complicating factor. There are many adults who experience 'silent' celiac and don't have the 'typical' symptoms. They also don't show the effects of the disease until it shows up with a bang when they are older. It's something that needs to be checked out. Now might not be the best time, and the GI doc might brush it aside, but whether it's now or later the possibility needs to be considered - bring it up. Unfortunately if it is a factor changing her diet now - and quickly - won't bring things into line immediately but it would certainly help things in the near future.
They will typically run blood levels every day to check for a number of different parameters. Do you happen to know those numbers and the trend of those numbers? It's difficult to 'guess' what might be going on without some basic levels.
Do you have a copy of the doc's notes from the operation and the pathology report that was generated from the initial operation? Some information on that would also be helpful.
I thought of something else, too. Could be your daughter has developed a problem with her bowels being shocked by all this and they're not moving and she's constipated, and that might also explain what the doc felt on that side, could be waste building up, and would perhaps explain the swelling and vomiting, altho I still think she has an abdominal infection. So, in addition to asking the questions that the goodly CalGal brought up, and the ones I mentioned in my previous post, you could also ask them if she is constipated, there are things they can do to relieve that.