Post-appendectomy Persistent Pain: Causes and multifactorial management

Background and Objective: Appendicitis is a well-documented medical condition, with appendectomy being the definitive treatment. However, a subset of patients experiences persistent or recurrent right iliac fossa pain postoperatively. This study aims to identify the potential causes of post-appendectomy pain and propose diagnostic and therapeutic strategies. Methods: A prospective study was conducted at a tertiary care hospital between September 2022 and August 2024. Seventy-two patients who experienced persistent right iliac fossa pain two months post-appendectomy were included. Patients underwent detailed clinical, laboratory (CBC, KFT, LFT, ESR, CRP, urine analysis), and radiological investigations (USG abdomen and pelvis, X-ray abdomen, CT abdomen and pelvis). Exclusion criteria included age <18 years, female patients, prior history of urolithiasis, and lack of consent. Data were analysed for demographic distribution, surgical history, pain characteristics, imaging findings, and further interventions. Results: The highest incidence was among young adults aged 21-30 years (32%), with a male-to-female ratio of 1:1.18. The most common type of appendectomy performed was open appendectomy (48.61%), followed by laparoscopic appendectomy (36.11%).54.16% of patients experienced continuous pain, while 22.22% had colicky pain. Ultrasonography revealed multiple aetiologies, including free fluid in the pouch of Douglas (14 patients), multiple sub-centimetric lymph nodes (12 patients), right ovarian cysts (8 patients), and ureteric calculi (11 patients).CT scans and additional laboratory testing confirmed tuberculosis (4 patients) and adhesions (3 patients).Surgical interventions included laparoscopic adhesiolysis (3 patients), mesenteric lymph node biopsy (2 patients), and laparoscopic completion appendectomy for stump appendicitis (2 patients). The majority (65 patients) were managed conservatively. Conclusion: Post-appendectomy persistent pain is a multifactorial condition requiring a systematic approach to diagnosis and management. Common aetiologies include adhesions, stump appendicitis, urinary calculi, gynaecological disorders, and infective causes such as tuberculosis. A combination of clinical evaluation, imaging modalities, and targeted interventions helps in optimizing patient outcomes. Future research should focus on refining surgical techniques and developing preventive strategies to minimize post-appendectomy complications.