What could be the cause of post-surgical pain in my abdomen after gallbladder surgery?

Question

Hi doctor,

I had a severe episode of gallstone pancreatitis and had to stay in a hospital for 17 days. They removed my gallbladder laparoscopically, and after only a few hours of surgery, I started feeling severe pain in my abdomen just right above the belly button (only a small area), they did many blood tests, but everything came normal. So the next day, my surgeon prescribed me opioids for five days with other pain medications to control the pain and discharged me from the hospital.

Then I gradually started feeling better, but after five days, when I stopped taking opioids, the pain came back at the same site (right above the belly button), and this time it was worst than earlier. Normal pain medications were not working at all. So my surgeon re-prescribed the same medication to control the pain, and I have started feeling better again since then. Although I am feeling better now, I am pretty sure the heavy dose of opioids is masking the actual problem, and the pain will come back when I stop using them.

I am sharing a few ultrasound images (transverse) taken exactly from the pain site, right above the belly button, showing a small lesion with a bright structure. It seems like a clip or something. I know these images are not enough to diagnose anything. Still, hopefully, you can give me a general idea if there is something wrong or if it is just a lesion because of laparoscopic cholecystectomy.

Thank you for your time.

Answer 1

Hi,

Welcome to icliniq.com.

I hope you are doing good. So I went through the ultrasound images (attachment removed to protect the patient's identity) provided to me and have made the following observations. There is evidence of a hypoechoic (dark area on ultrasound) in periumbilical location (assuming the probe was placed at the site depicted by you in the drawing). It would be indicative of a normal fluid at port site in post laparoscopy cholecystectomy within four to five days of surgery. Beyond this period, in a patient having pain, tenderness at the port site could indicate the following,

1. Post surgical infected fluid collection.

2. Post surgical hematoma formation.

Now when I see image (attachment removed to protect the patient's identity), it could also be a hernia at the port site which would give a similar image on ultrasound. But again difficult to say on a single image. White dots seen in black region in later images could be air foci. Having said that you must be aware that ultrasound is a completely operator dependent modality and the quality of images taken depends entirely upon the experience and expertise of the ultrasound technique. Also, seeing something real time versus in still images is very different. I also observe that there are no measurements of this area (dark area) on the images which is surprising.

I hope you are aware that there is usually follow up for first few days or weeks in cases of laparoscopy cholecystectomy with the surgical team that has operated upon a patient. Was this done in your case? I am asking this because you are symptomatic and the dark region in the images needs to be evaluated further, therefore I suggest you see your surgeon for this.

I hope this helps. Take care.

What could be the cause of post-surgical pain in my abdomen after gallbladder surgery?

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