Incision pain 12 days after surgery

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JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 16, 2021 8:42 am

I had a sigmoid colectomy on October 4th. They gave me tramadol for the pain, 50 mg every 4 hours. I stopped taking it for a bit because I didn't like the way it made me feel. But the pain is very intense. Yesterday I thought I would have to go to the er.

There are no signs of infection. No pus no red streaks no fever. Just this terrible stabbing pain that requires that I take the tramadol every 4 hours. Is this normal? The surgeon led me to believe that the pain should be gone by now. Has anyone ever experienced this type of pain this long after surgery?
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

Koreysue
Posts: 229
Joined: Mon Apr 30, 2018 2:36 pm

Re: Incision pain 12 days after surgery

Postby Koreysue » Sat Oct 16, 2021 3:14 pm

When I had my resection, the pain lasted about 2 weeks pretty severely. After that it started to improve. Is it stabbing even when sitting still, or is it with only movement? Make sure you are not doing too much! If it is even happening at rest, you should call your doctor and run it by them. Something that helped me is a large soft ice pack that I got on amazon. It’s the kind that stays squishy even when cold. So helpful.

Ksue
Dx: 6/2017 stage 3 colon cancer
Sigmoid, 2 nodes
CEA at dx: 6.1
Sigmoid Colectomy/folfox (chemo complete January 31, 2018)
CEA 4/2018: 2.4
CEA 7/2018: 3.7
Colonoscopy 8/2018 clean
PET scan 8/20/18 NED
CEA 11/2018: 3.8
CEA 2/2019: 3.2
CT NED 6/18/2019 / CEA : 3.4
CEA 10/21/19: 3.2
CEA 3/9/20: 3.8
CT NED /CEA 6/17/20: 3.8
CEA 11/4/20 4.6 <——— whyyyy? (will retest in a few weeks)
CT NED 12/1/20 CEA: 3.5 (happy to see a lower number)
CEA 5/17/21 4.2
CEA 10/18/21 3.4
colonoscopy 10/2021 10mm polyp

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 16, 2021 3:27 pm

Thank you! If I am still, the pain is less but still there. It's when I move or walk, typically hunched over, that it gets worse. I will try the ice pack.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

Koreysue
Posts: 229
Joined: Mon Apr 30, 2018 2:36 pm

Re: Incision pain 12 days after surgery

Postby Koreysue » Sat Oct 16, 2021 3:42 pm

Yes, do try it! I think you will start to feel better in the next couple of weeks.
Thinking of you,

Ksue
Dx: 6/2017 stage 3 colon cancer
Sigmoid, 2 nodes
CEA at dx: 6.1
Sigmoid Colectomy/folfox (chemo complete January 31, 2018)
CEA 4/2018: 2.4
CEA 7/2018: 3.7
Colonoscopy 8/2018 clean
PET scan 8/20/18 NED
CEA 11/2018: 3.8
CEA 2/2019: 3.2
CT NED 6/18/2019 / CEA : 3.4
CEA 10/21/19: 3.2
CEA 3/9/20: 3.8
CT NED /CEA 6/17/20: 3.8
CEA 11/4/20 4.6 <——— whyyyy? (will retest in a few weeks)
CT NED 12/1/20 CEA: 3.5 (happy to see a lower number)
CEA 5/17/21 4.2
CEA 10/18/21 3.4
colonoscopy 10/2021 10mm polyp

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CRguy
Posts: 10347
Joined: Sun Feb 10, 2008 6:00 pm

Re: Incision pain 12 days after surgery

Postby CRguy » Sun Oct 17, 2021 12:17 am

JMRWife wrote:Thank you! If I am still, the pain is less but still there. It's when I move or walk, typically hunched over, that it gets worse. I will try the ice pack.

Sorry for your pain ... BUTT ... also BTDT and you have ID'd some very important issues.
With NO fever, discharge, and it being kind of positional, you have kind of ruled out an abscess/infection
BUTT keep on top of this and with any changes ... CALL YOUR DOCS !!!!!

I did have a pelvic abscess and had pain and fever, just FYI.

From the surgery side though :shock:
as a Vet (40 years) and a CRC patient (since 2007), I do know about post-op surgical issues.

Sometimes the healing process causes contraction of the tissues ( shrinkage )
sometimes the actual surgery puts tension / traction on tissues and nerves,

As things heal, the "shrinkage" causes pain OR if a nerve has been cut or trapped, it causes pain.

If the pain is too much, too long lasting, too intolerable ...
Get a pain specialist on board !!!!

" Sometimes pain is inevitable ..
Suffering from it ... IS NOT ! "

CRguy on the Journey
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sun Oct 17, 2021 8:57 am

Many thanks, CRguy! I called my surgeon Friday but he did not call me back. I'm going to call him again tomorrow. I do find that if I stretch gently the pain subsides. So I'm going to try to do a lot of stretching today.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Fri Oct 22, 2021 8:35 pm

I had surgery almost 3 weeks ago and the pain is not getting better. If anything it's a bit worse. There are still no signs of infection. WTF? When will this get better?
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

User avatar
O Stoma Mia
Posts: 1691
Joined: Sat Jun 22, 2013 6:29 am
Location: On vacation. Off-line for now.

Re: Incision pain 12 days after surgery

Postby O Stoma Mia » Sat Oct 23, 2021 12:50 am

Since you are still having pain and still asking for feedback, I think it would be good if you could provide a little more information in the following areas. This might help people focus on the problem.

  • Types of surgical procedures actually done on October 4
    You said that you had a "laparoscopic sigmoidectomy" done and that they removed your temporary colostomy, but it must have been more complicated than just that.
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65906&p=510594#p510594

    You need to itemize all of the procedures and sub-procedures, and try to find out their associated CPT codes. There are at least several procedures that you haven't explicitly mentioned: (1) creation of an anastomosis junction to connect the remaining colon with the rectum, (2) mobilization of the left colon at the splenic flexure (SFM) "Splenic Flexure Mobilization" so that the remaining colon can reach all the way down to the rectum for the anastomosis, and (3) cleaning up and closure of the temporary colostomy incision. There may be more, for example, repair of a parastomal hernia at the site of the stoma (if in fact there was a hernia there), or removal of adhesions left over from the original surgery, etc. If you have access to the surgery report you might be able to figure it out, or you could ask the surgeon for the details if you are ever able to talk to him.

    You said earlier that it would be "just a sigmoid colectomy", but it couldn't have been that simple.

    I think you need to have another look at the main CPT codes that are relevant for this type of complex surgery:
    https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65893&p=510499#p510499
    .
  • Which incision?
    You say that you have incision pain, but which incision? There are at least 4 or 5 incisions involved -- 3 small ones from the laparoscopic procedure, and one larger one where they removed the resected sigmoid colon. Then there is the incision for cleaning up and closing the temporary colostomy exit on your left side. There is also a very tiny incision where they had inserted a temporary post-surgery drain tube, and maybe a very small opening near the spine where the epidural pain medicine had been infused. Which incision is causing the pain? And are you sure that the pain is coming from an incision and not referred pain coming from somewhere else? Could it come from a small bowel obstruction (SBO) due to kinks in the bowel caused by adhesions from prior surgeries?
    .
  • Where does it hurt? You haven't mentioned much about where, exactly, the pain is located and what you are doing when the sharp pain appears -- e.g., sitting at a desk? walking? lying down in bed? etc. You haven't mentioned if the pain gets worse if you press in certain areas, and where those areas are located.
    .
  • When and why did this pain first start. You said that everything was just fine right after surgery, but that this problem emerged 12 days afterwards. What were you doing just before this new onset of pain?

So, what I'm saying is that the more information you can provide the better the replies you might receive from members here.

DarknessEmbraced
Posts: 3666
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Facebook Username: Riann Fletcher
Location: New Brunswick, Canada

Re: Incision pain 12 days after surgery

Postby DarknessEmbraced » Sat Oct 23, 2021 7:20 am

I'm sorry you're experiencing pain. *hugs* For quite a while after my colon in 2014, I would experience a stabbing/ burning type pain after bowel movements. My surgeon said it was nerves regrowing. It was awful and would have me doubled over. It eventually went away on its own. I hope your pain will be the same way and that you feel better soon. *hugs*
Diagnosed 10/28/14, age 36
Colon Resection 11/20/14, LAR (no illeo)
Stage 2a colon cancer, T3NOMO
Lymph-vascular invasion undetermined
0/22 lymph nodes
No chemo, no radiation
Clear Colonoscopy 04/29/15
NED 10/20/15
Ischemic Colitis 01/21/16
NED 11/10/16
CT Scan moved up due to high CEA 08/21/17
NED 09/25/17
NED 12/21/18
Clear colonoscopy 09/23/19
Clear 5 year scans 11/21/19- Considered cured! :)

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 23, 2021 8:44 am

I just can't believe I went through a first surgery, then nine rounds of chemo, then another surgery and this is the thing that hurts the most. Sorry if I'm whining. I'm away on a long weekend and I had to miss a concert that I was supposed to go to cuz I can't walk straight. It's ridiculous. The doctor keeps saying that I have to keep moving keep moving keep moving.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 23, 2021 8:53 am

The pain is constant, not after BM. O Stoma Mia, thank you for your usual thorough response. It is the major incision, not the smaller ones. I do not think it is referred pain. My BMs do not hurt and seem normal. When I called the surgeon the nurse was really snotty to me and intimated that they would not give me any more opioids, which I did not ask for. All I want to know is why this continues to cause me pain. I will try to find out the surgical codes and post back.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 23, 2021 8:55 am

No codes but this is the description of what they did in the surgery. From the operative report.

OPERATION:
Colonoscopy to cecum.
Laparoscopic hand-assisted sigmoid colectomy with coloproctostomy.
Rigid proctosigmoidoscopy.

ANESTHESIA: General.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

JMRWife
Posts: 99
Joined: Mon Oct 05, 2015 9:41 pm

Re: Incision pain 12 days after surgery

Postby JMRWife » Sat Oct 23, 2021 8:57 am

The pain is a 5/10 when still and 8/10 when walking.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Neoadjuvant Folfox 5/18; CEA 107.
9/8: 9 rounds Folfox completed. CEA 2.1.
Pathology: COLON, SIGMOID: -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED Clinical stage IIA.

9/28/21 CAT scan: Tumor was 6.4 x 3.8 cm, now 2.6 x 4.5 cm.

10/4/21: Sigmoid colectomy. 36 lymph nodes removed, 0 cancerous. Stage T2N0M0.

User avatar
CRguy
Posts: 10347
Joined: Sun Feb 10, 2008 6:00 pm

Re: Incision pain 12 days after surgery

Postby CRguy » Sat Oct 23, 2021 12:01 pm

Could be nerve entrapment or scar tissue contraction.
I would try to get a pain management specialist on board for a proper assessment.
There can be procedures to deaden the affected nerve for local effect.

Best wishes
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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O Stoma Mia
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Joined: Sat Jun 22, 2013 6:29 am
Location: On vacation. Off-line for now.

Re: Incision pain 12 days after surgery

Postby O Stoma Mia » Mon Oct 25, 2021 7:53 am

JMRWife wrote:No codes but this is the description of what they did in the surgery. From the operative report.

OPERATION:
Colonoscopy to cecum.
Laparoscopic hand-assisted sigmoid colectomy with coloproctostomy.
Rigid proctosigmoidoscopy.

ANESTHESIA: General.

The description of your surgery looks a litle incomplete to me. In particular, it doesn't mention anything about a Splenic Flexure Mobilization (SFM) procedure. So one thing you could do next time you talk to the surgeon is to ask him whether he did the SFM procedure, or if he just decided to skip it. It might have some impact on your current problem with incision pain. I'll explain below.

From what I've read recently, it seems that the SFM procedure has always been deemed to be an an essential part of any rectal or sigmoid resection whenever a section of the rectum/colon is removed and the remaining pieces are joined together at an anastomosis. This was thought to be needed so that the new anastomosis would be a "tension-free" join. (Thus, in order to make the join a tension-free join they would have to basically unattach the descending colon at the splenic flexure so that it could be moved down a few inches in order to make up for the loss in length due to the removal of the resected section and which would then allow the descending colon to connect to the rectal stump with ease.)

Apparently what has happened just recently in the past few years is that some surgeons (about 30% of them) have decided that it is too difficult and too time-consuming to do the SFM procedure, so they just skip it. Instead, what they do is to leave the splenic flexure in place and then stretch the descending colon so that it becomes long enough to reach the rectal stump. This then leaves the patient with a "high tension" anastomosis connection -- i.e., a connection that might put some strain on the junction if the descending colon tries to return to its original length, and which might possibly cause some pain if such tension-based contraction ever occurs. There have been several articles in the literature where the authors basically say that it is preferable to skip the SFM procedure for one reason or another.

I'm not sure if this is relevant to your current pain problem, but I thought I would mention it anyway just in case it might shed some light on the issue.


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