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Post-op complications Post-op complications

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Unread 04-16-2003, 09:38 AM
Post-op complications

I am a nurse who underwent a TAH with Paravaginal repair on March 4, 2003. From the moment I got out of surgery, I started to develop complications. The first night, they could not get the pain under control and kept giving me Morphine which in turn made me sick. I started throwing up. My dressing was saturated with blood before night fall. The next morning when the doctor came to see me, the staples had popped out of the middle of the incision and the wound was starting to dehiss. I was scared and he spoke about the possibility of returning to surgery. He said that I had developed a seroma. In sixteen years of nursing I had never heard of a seroma. Later that day, he explored the wound in my room and told me that the abdominal fascia was still intact and that I would not need to return to surgery. I was relieved, but that was only temporary. The post-op pain in the hospital was unbearable. The day I was discharged, I got up to the bathroom and something gave way in my incision and blood and serous fluid spewed all over the bathroom and me. I panicked and the nurse called the doctor to the room. He told me not to worry about it that it may still drain some and went ahead and sent me home. When I got home, I did not do well at all. My abdomen continued to get harder and harder. I ran a low grade temp and was throwing up frequently. I was ghostly pale and could hardly walk. Two weeks post-op, I kept smelling something strange, and I went to the bathroom, the wound came open and fluid was pouring out like a waterfall. I went to the ER and guess what! My doctor was out of town. One of his associates put me in the hospital. They could not see anything on the ultrasound because the fluid in my abdomen was blocking their view. The radiologist put me in the cat scan and it showed I had a huge 13cm mass of fluid and blood in my abdomen. I was horribly depressed at this point and had cried all night the night I came into the ER. That night, they took me back to surgery and evacuated over 200cc of fluid and a huge blood clot that had formed on top of my bladder. He said that there was fluid in my abdominal wall and that it was very inflammed. He put a drain in to help prevent any reaccumilation of fluid. I felt so much better the next day. When I was discharged, he pulled out the drain. I wanted to keep it because I was so fearful of the fluid reoccuring. My recovery has been rough, and I am still having a lot of pain, especially on the side where the induration in my muscle wall occured. It is getting close to time to go back to work and I was concerned about the pain. My doctor ordered an ultrasound. I went yesterday and the US took over an hour. The radiologist and two US techs were all looking at the US and saying, "Is that bone?" I was about to pop I had to pee so bad. They made me wait while the pulled out my old films. The radiologist said that the fluid had reformed and that there was another blood clot. Earlier this week, I felt that my abdominal wall was giving way, and now I can put my finger in a hole that appears to be a hernia forming. I called my doctor and requested an appointment and they told me that he is going out of town. I insisted that I was having problems so they are going to work me in today.
I am very fearful that I am facing yet another surgery. The pain is so bad that just walking makes me hurt. I imagine that is the fluid that is irritating the abdominal wall. Does anyone think that at some point a general surgeon should be called? Is it presumptuous for me to call and get an appointment with a general surgeon or should I wait and ask my GYN to refer me? He is going out of town and I don't think this should wait until he gets back. I know I should be enraged with what has happened to me. If I tell him how I really feel, I am afraid that he will abandon me and not help me at all. Do other women have complications this bad after surgery? I don't think a soap-opera plot could even be this bad. I can't believe this is happening to me. I am so depressed and scared. I can't cry, it would just make matters worse. I had multiple fibroids, endometriosis, and a relaxed bladder. I'm starting to think I would have been better off without the surgery. I was so sick though. I was having a fourteen to eighteen day cycle and the pressure on my pelvic floor was making work impossible. I also learned that I had mono a few days before the surgery. My GP and Gyn both thought that it wouldn't cause any complications with the surgery. I have wondered if the mono is why I haven't done well.
I need some encouragement. My family is astonished with everything that has happened. I feel like I have worn out my welcome at home because I have been so sick. I am so frustrated because I can't take care of myself and fulfill my responsibilities around home. I'm so sad and frustrated. Does anyone have these kind of problems? Surely, I am not alone in this.

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Unread 04-16-2003, 09:51 AM
Post-op complications

Wow, I cannot even imagine. Have you gotten a second opinion from another GYN? If I were you I would not go back to that same Dr. No way, no how. Sounds like you are a very nice person and don't want to offend this Dr. but it is time to get someone who is taking you seriously. Really.
Unread 04-16-2003, 09:54 AM
Post-op complications

I don't know what to say except I'm so,so sorry to hear what has been happening to you! I haven't had complications from my surgery, so I can only imagine what you must be feeling. PLEASE don't be afraid to question your doctor or to see other doctors on your own. If your doctor stops treating you because you are questioning him, then this doctor is not the one for you anyway. Since you are a nurse, perhaps someone you know could give you names of other doctors to see. Please let us know how you are doing. Hugs to you!
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Unread 04-16-2003, 09:56 AM
post-op complications

I agree with mavenatl, get another GYN's opinion immediatley. Find someone sympathetic who will take your problems seriously. Perhaps one of the hyster sisters in your area could receommend someone.
Keep in touch.Take care of yourself
Unread 04-16-2003, 11:03 AM
Post-op complications

Dear Wrinkles,
I thought I had it bad when my incision popped open due to a seroma after they removed my staples!
You poor girl! Hang in there!
My tells me that the seroma is caused by a pocket of adipose (fat) tissue forming under the staple line. It liquifies and ...splat! It is luck of the draw whether you get one or not, although a chubbette like me has a greater chance. Today, at my 3 week checkup I asked if I could expect to get another if I had any additional surgery and the reply was...Maybe/Maybe not!
I am comfortable with my doctor and the treatment I am getting from my DH, who helps me clean it each evening, but if I was not, I would be on the phone getting some help, either from the other doctors in the practice, or another gyn referral by my family doctor.
It is a scary thing, as it is, and you have had far too many problems with your recovery to leave it to fate.
There are many links through some of the threads on this website to give you additional guidance. Search on seroma or abcess.
I will be for your recovery.
Unread 04-16-2003, 12:56 PM
Post-op complications

Sorry to hear of your complications. I know all too well as I had a complication too and it required another abdominal surgery 3 months after my TAH. I had a vaginal fistula and was catheterized for 5 months. YIKES. I see my urolgist tomorrow and I am SO afraid that I'll develop another complication. I just don't feel strong/right????

I agree with the other woman. Get another opinion. Listen to your body. Take care and I hope you feel better soon.

Unread 04-17-2003, 07:58 AM
Post-op complications response

Thank you so much for everyone's response! I am overwhelmed to hear from all of you so quickly. I returned to the doctor yesterday and pretty well put everything on the line. He admitted that he did not know what was causing my pain that it could be the formation of a hernia, a nerve impingement, an ovarian cyst but felt that it was unlikely the endometriosis. If I had known there was endometriosis on my remaining ovary I would have opted to take it out. It is likely only to continue to cause problems unless I go through early menopause.
My doctor and I both agreed that I needed to see a General Surgeon because I have had so much trouble with the wound healing. I have worked with a excellent General Surgeon and after reading your notes I had the courage to go ahead and place a call to him before seeing my GYN. Bless his heart! He called several times and left messages for me. (I was at my GYN appointment). He left his beeper number and told me to call him.
Can you believe that? I called him and he listened to everything!
I couldn't believe it! He was very sympathetic and told me he was so sorry that all this had happened to me. I was so touched. It is rare indeed for a doctor to listen and show sympathy in this day and time. At any rate, I am to have a cat-scan to see what the problem may be. I have to get it precerted through my insurance first. He told me to come to his office right after I have the cat scan done. I am happy and relieved that my problems are being validated. Maybe we will have an answer to what the problem is soon. I just hope that I haven't developed a hernia. I am terrified of having surgery again! I hope to hear form you all again. Being able to talk about it helps so much. It has been hard for me to talk to my husband. He seems put out with me having so much trouble. It's not my fault though! I'll know more later.....
Unread 04-17-2003, 08:45 AM
Post-op complications

I am so sorry to hear what you have been through. I am glad you opted to go see a surgeon who sounds as if he is caring and skilled. Thinking of you and hoping things improve. I left the hospital saying I would never ever go back ( my doctor laughed at this) but the truth is sometimes we have to do what we don't want to- so if you have to go back, just remember that it is absolutely necessary so that you can feel better again!
Unread 04-18-2003, 11:58 AM
post-op complications

Well done,
You are moving in the right direction. Hope all goes well with the scan. Keep us posted .
Best of luck.
Unread 04-18-2003, 03:41 PM
Post-op complications

I'm so sorry you are going thru so much I didnt suffer complications like yours but I did have some from Adhesions. I underwent additional surgery for them @ 12 weeks Post & then again @ 16 wks Post which was an emergency. It does help having others who understand I'm soo grateful for finding HysterSisters
I'm glad you have such a caring & compassionate Dr...pls let us know how your upcoming tests & appt goes...
Here is some info on some possible complications following this surgery as well as some info on the DX's your Dr mentioned...hopefully they can give you some better insight as to what is going on:

Most commonly, a hysterectomy is done by an incision (cut) through the abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy). The hospital stay generally tends to be longer with an abdominal hysterectomy than with a vaginal hysterectomy (4 vs. 6 days on average) and hospital charges tend to be higher. The procedures seem to take comparable lengths of time (about 2 hours), unless the uterus is of a very large size, in which case a vaginal hysterectomy may take longer.

What are the types of hysterectomies?

There are now a variety of surgical techniques for performing hysterctomies. The ideal surgical procedure for each woman depends on her particular medical condition. Below, the different types of hysterectomy are discussed with general guidelines about which technique is considered for which type of medical situation. However, the final decision must be made from an individualized discussion between the woman and the physician who best understands her individual situation. Remember, as a general rule, before any type of hysterectomy, women should have the following tests in order to select the optimal procedure:
Complete pelvic exam including manually examining the ovaries and uterus.
Up-to-date pap smear.
Pelvic ultrasound may be appropriate, depending on what the physician finds on the above.

Total Abdominal Hysterectomy:

This is the most common type of hysterectomy. During a total abdominal hysterectomy, the doctor removes the uterus, including the cervix. The scar may be horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated. Cancer of the ovary and uterus, endometriosis, and large uterine fibroids are treated with total abdominal hysterectomy. Total abdominal hysterectomy may also be done in some unusual cases of very severe pelvic pain, after a very thorough evaluation to identify the cause of the pain, and only after several attempts at non-surgical treatments. Clearly a woman cannot bear children herself after this procedure, so it is not performed on women of childbearing age unless there is a serious condition, such as cancer. Total abdominal hysterectomy allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer or investigating growths of unclear cause.

Recurrent Endometriosis After Hysterectomy:
There is no question that endometriosis can be present in a woman who has undergone a hysterectomy and removal of both ovaries (even more likely if the ovaries remain). Performing a hysterectomy does not in itself treat endometriosis. It may reduce the chance of future recurrence of endometriosis, reduce non-endometriosis related cramps, bleeding etc. The key point is that endometriosis, for the most part, does not grow on the uterus, it grows behind the uterus, on the bowel, in the rectovaginal septum, in the pararectal spaces, under the ovaries, around the ureters, on the bladder, etc. If a hysterectomy is part of the agreed upon treatment plan between you and your physician that is fine, but ONLY AFTER the endometriosis has been completely removed from all of the areas which will not be taken out with the uterus. If you have undergone a hysterectomy alone for the treatment of endometriosis (the endometriosis was not treated just prior to the hysterectomy) there is a good chance you will have persistent or recurrent symptoms. The most common symptoms include constant pain, pain with bowel movements, pain with intercourse (usually deep penetration, like he is hitting something inside) and occasionally mid back pain (secondary to ureteral involvement). You can also experience the emotional changes we have seen with endometriosis including moodiness, depression, etc. Now, assume for a minute that everyone understands your situation (your doctor, significant other, employer etc.) and your gynecologist surgeon is standing there ready to go after the endometriosis. What are the pitfalls? In my experience, by the time a patient has gotten to this point she has undergone so many surgical procedures that is impossible to tell what is and what is not endometriosis. The anatomy is distorted, fairly extensive scar tissue and fibrosis (tough leathery tissue) is present, and often endometriosis is buried out of sight in a patient who has had a hysterectomy performed. The endometriosis gets buried when the surgeon clamps, cuts and ties the tissue during the hysterectomy. The endometriosis that is present get wadded up and buried in this process. After this area heals following the surgery it can be impossible to see endometriosis without dissecting the areas in which endometriosis is known to grow. Another common area for residual endometriosis is the vaginal cuff. Unless all of the endometriosis is removed from the rectovaginal septum prior to the hysterectomy, it can be easily sewn into the vaginal cuff. We have seen and treated more than 200 women with residual endometriosis after undergoing a hysterectomy. If you are experiencing this situation, you are not alone. In my experience there are several key factors in successfully treating this type of case. First, this is probably the most technically challenging surgery a gynecologist will face. It is important to seek out a surgeon who is technically good and has experience in dealing with this situation. Second, since it can be impossible to determine what is and what is not endometriosis, all abnormal tissue must be removed and the areas in the pelvis where endometriosis is know to grow must be dissected out. It is not uncommon for an area to look normal on the surface, but to have deep endometriosis when opened up. In my experience, all areas need to be dissected down to normal tissue (endometriosis until proven normal). Depending on the specific situation a small portion of the vaginal cuff may need to be resected. In summary, you can have endometriosis and the associated symptoms and pain even if you have had a hysterectomy. Treatment of this condition is technically challenging and requires the ability, expertise, and equipment to dissect and laser all of the pelvic areas deep down to normal tissue. In my opinion, a surgeon can not get all of the endometriosis and scar tissue by just spot treating or selectively excising lesions. In my experience, once all of the pelvic area is explored and all the abnormal tissue is laser out, the patient feels better.
Hysterectomy - complications of both abdominal and vaginal:

Abdominal Abscess :

Pelvic and Abdominal Pain and Endometriosis:

MRI is an excellent modality for the evaluation of postoperative seromas:

Hernia: What You Should Know:

Inguinal Hernia:
Scar articles, support groups, and resources:

Nerve damage at time of hysterectomy:

Nerve damage after surgery:

Pelvic Surgery or Trauma:
Ilioinguinal Nerve Entrapment and Pain:

FAQ'S-Ovarian cysts:

Good Luck I hope you are able to find some answers & relief to all this soon....(((((hugs)))))

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