Was in ER, had surgery six months ago, having pain still, have some questions?

[starangel777]

Hi Dr.,

I am 31 years old and six months ago had laparascopic surgery to remove a almost 6cm tubal cyst that resulted in partial fallopian tubal removal of about 3cm. I have been still having pain in that area and also to complicate things further have some type of endocrine disorder that is still being tested out (possible cushings or pcos), with very high testosterone, dheas, acth, etc. For example my free testosterone levels were at 13.8 (normal should be less than 6.2) and dheas of 679(normal less than 325) and ACTH of 52 (normal less than 27). Also I have a condition called empty sella.

Anyway, a few days ago the pain in that area intestified a thousand times and I thought I would faint from it, I had two episodes like that that day. Still had pain yesterday so the gyn could not see me until next week and told me to go to the ER. The ER did a CT scan that said everything was ok except that I had "tiny hypodense right adnexal lesions noted, likely ovarian in nature." and to follow up with my gyn.

What does this mean? Could that be the reason for the severe pain? Also, I have an appt. with a new gyn as I am not happy with present one but not for two more weeks, is that ok to wait?

Thank you so much,

Marie

[Annekathryn Goodman, M.D.]

Dear Marie,
I apologize about my delay!

My immediate thought is - could you have a hernia at the site of your laparoscopic incision? The ER visit is reassuring in that at that time, you did not have anything life -threatening going on (which is the purpose of the ER). It sounds like you probably have a normal cyst of ovulation based on the CT scan report.

I do not think your endocrine issues are related to the pain.
So that gets back to something about your surgery:

It is not rare to develop a hernia in the incision site  (what is called portsite). Because laparoscopic surgery uses small incisions, sometimes it is hard to make this diagnosis (of a hernia).

A hernia is a weakness or opening in the fascia. Fascia is the white tissue that covers muscle and it it the strength layer of the abdominal wall. If you get a hernia, a small area of intestine can push through the incisional opening and get stuck. That hurts. Frequently the pain can come and go because of intestine drops back into the abdomen. But then if you lift something heavy or cough and strain, the intestine can be pushed back through the hernia.

You should ask your doctor about that possibility. The diagnosis is made by physical exam.
take care

[starangel777]

Thank you SO much Dr.

I never thought about the hernia issue, but I will DEFINATELY ask my new gyn who I will see next week.

Thank you again for your help!

Marie