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Nov 20, 2019

Severe post-surgery pain after eating, seeking advice

This topic is about a person experiencing severe abdominal pain after surgery, specifically following a right hemicolectomy and the creation of a temporary ileostomy. The pain occurs every time they eat, even with soft foods, and radiates around the stoma and right ovary. Despite various tests and consultations, the cause of the pain remains unclear. Here are some insights and advice shared by others:

1. Do not accept unexplained severe pain. It's important to insist on further investigation.

2. Consider seeking additional opinions from gastroenterologists and radiologists who specialize in inflammatory bowel disease and postoperative anatomy, as different experts may interpret scans differently.

3. For imaging, try to have a CT or MRI during a pain episode, or do baseline imaging when pain-free, then eat and repeat imaging as pain begins. This might help identify transient obstructions or other issues.

4. Possible causes to explore include:
- Undiagnosed Crohn’s disease or ulcerative colitis.
- Internal obstruction or stricture that doesn't affect stoma output yet.
- Vascular events like mesenteric or portal vein thrombosis.
- Trapped gas due to a peristomal hernia or bowel kinking.

5. Keep a detailed diary of food intake, pain onset, duration, stool consistency, gas, any blood, and body temperature to help identify patterns.

6. If gas is suspected to be involved, try gentle walking, lying on the left side, or using an inversion table to help gas move. Avoid carbonated drinks, straws, and gum, and chew food thoroughly.

7. Be aware of red flags such as rising temperature, signs of sepsis, or uncontrolled pain, which require immediate medical attention as they could indicate serious complications.

8. Persist in requesting repeat imaging or exploratory evaluations, as bowel segments can shift or become trapped even after initial scans appear normal.
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