It wasn’t appendicitis. My appendix was inflamed and we took it out (that’s what I do these days), but my surgeon thought it might have just been caught in the crossfire of the other issue. Pathology later confirmed there was never any appendicitis.
It was acute small bowel volvulus: in pretty terms, when your small intestine ties itself in a bow and (as you can imagine) stops working after that. A volvulus in and of itself is not uncommon; however, volvulvus of the small intestine (something occasionally seen in infants or young children as a birth defect) is extremely rare in adults. So uncommon, in fact, that the studies on the issue show only a handful of cases every year, and there are only a couple studies I could find on it at all, quite frankly.
Because it’s so rare, the question of the hour is why did it happen to me? Or, in medical terms, was this primary or secondary small bowel volvulus (i.e., did this happen on its own or did something cause this to happen)? The obvious trigger is my hysterectomy — in fact, in the most recent study I could find, which identified 35 cases of acute small bowel volvulus in adults over a ten year span, 23 of those cases had had prior abdominal surgery. However, in those cases, the cause of the volvulus was obvious: postoperative adhesions.
I had no adhesions. I had no nicks, leaks, adhesions, or other obvious signs that something was amiss. And I am pretty convinced, based on everything my surgeon had to say, that he checked thoroughly. “Absolutely none,” he said emphatically in his quasi-German accent.
As for primary acute small bowel volvulus, because it is so rare, they have no idea what causes it.
But as I said when I thought it was appendicitis, could I be that unlucky? The two surgeries surely have to be related in some way, even if it isn’t obvious.
Whether it was primary or secondary — and for the sake of my sanity I am assuming secondary — I will undergo a number of tests, including repeat scans, beginning in a few weeks when I have healed enough to see if we can learn anything else about why this happened.
Is it likely to occur again in the future? Not necessarily — in the study I referenced above, three of the 35 patients had this happen more than once; however that was not explored further, and there really isn’t a reason to assume this would happen again, aside from the fact that we don’t have a reason why it occurred in the first place.
The one thing that is certain, though, is that in any case, immediate surgery is critical, and I am grateful that my CT scan showed enough junk and inflammation (even if it didn’t actually show them what was wrong) to get them to move quickly toward surgery. And as I mentioned in my previous post, the doctor on call in the ER was very firm that surgery was urgent (if only to deal with my ruptured-not ruptured appendix).
Pics in order:
1. surgery one, 1 day post-op (three total incisions inc. belly button);
2. surgery one, 3 weeks post-op;
3. surgery two, 1 week post-op, and 6.5 weeks from surgery one (one long incision, still taped, and one shorter incision exactly along my star tattoo — my surgeon was quite pleased with his creativity on that one).
So now it’s back to recovery, though this one is much more difficult than the last. Not all laparoscopic surgeries are alike, apparently. I’m one week post-op and still struggle to get up and down, walk much, and move around. I still feel shortness of breath and nausea when I first start walking, and if I sneeze or cough… well, I may as well be ripping my stitches out. But I do feel some improvement (slowwwww improvement), and I am confident I’ll be able to go for some walks by the weekend — at least get out of the house!
I have another six weeks of restrictions (if we’re being honest, “at least 6 weeks” may be more what my surgeon said), which means, of course, no paddling, but also none of the other things I was looking forward to — like picking up the kids and swimming in the pool with them. In April, I had planned a trip — a reward for getting through the other surgery! — to NC to paddle with the #1 female paddler in the world who is flying in from New Zealand. It was only for a night, but I had a nice hotel room, and I was so looking forward to it. I canceled it already — on Monday, when I was exactly 6 weeks out from my first surgery and had big exclamation marks on my calendar indicating the end of recovery. That definitely hurt a bit.
But here we go again. Hopefully by this time next week, my mornings will be recovery walks on the beach and sea glass in my pockets. And maybe this time around, I won’t need winter coats and hats.