What is the etiology of chronic nausea and vomiting in a patient one year post-appendectomy?

From the Guidelines

The etiology of chronic nausea and vomiting in a patient one year post-appendectomy is most likely related to post-surgical adhesions or bowel obstruction, which can cause intestinal obstruction and subsequent nausea and vomiting. This condition can be evaluated and treated based on the patient's symptoms and medical history, as seen in a case presentation of an 81-year-old woman with a history of laparotomic appendectomy 1. The patient's symptoms of intermittent acute abdominal pain and vomiting, along with the presence of localized peritonism in the lower right quadrant, suggest a possible bowel obstruction.

Some possible causes of chronic nausea and vomiting in this patient include:

• Post-surgical adhesions, which can form after any type of abdominal surgery, including appendectomy
• Bowel obstruction, which can be caused by adhesions, hernias, or other conditions
• Functional gastrointestinal disorders, such as gastroparesis or chronic intestinal pseudo-obstruction
• Medication side effects, particularly from opioids or NSAIDs
• Underlying conditions, such as gastroesophageal reflux disease (GERD), peptic ulcer disease, or gallbladder dysfunction
• Psychological factors, including anxiety, depression, or post-traumatic stress related to the surgical experience

Initial management should include a comprehensive history and physical examination, followed by diagnostic tests such as upper endoscopy, abdominal CT scan, gastric emptying study, and laboratory tests to evaluate liver, pancreatic, and thyroid function. Treatment depends on the identified cause but may include prokinetic agents, antiemetics, or acid suppressants, as well as dietary modifications to support the patient's recovery. For example, a study on bowel obstruction highlights the importance of early diagnosis and treatment to prevent complications 1.

In terms of specific treatment options, prokinetic agents like metoclopramide 10mg three times daily before meals, antiemetics such as ondansetron 4-8mg every 8 hours as needed, or acid suppressants like omeprazole 20-40mg daily may be considered. Additionally, dietary modifications, including smaller, more frequent meals and avoiding trigger foods, can help manage symptoms while the underlying cause is being addressed.

From the Research

Etiology of Chronic Nausea and Vomiting

The etiology of chronic nausea and vomiting in a patient one year post-appendectomy can be complex and multifactorial. Some possible causes include:

• Postoperative nausea and vomiting (PONV) complications, which can range from minor patient discomfort to gastric aspiration or death 2
• Cyclic vomiting syndrome, which can be triggered by recurrent or chronic appendicitis 3
• Abdominal wall abscess, which can occur even years after appendectomy 4
• Other factors that stimulate the vomiting reflex, such as anesthesia and surgery-related factors 5, 6

Contributing Factors

Several factors can contribute to the development of chronic nausea and vomiting after appendectomy, including:

• Anesthesia-related factors, such as the use of certain anesthetic agents 5, 6
• Surgical factors, such as the type of surgery and the presence of complications 2, 4
• Patient-related factors, such as age, gender, and medical history 5, 6
• Other factors, such as mast cell counts and histological changes in the appendix 3

Potential Triggers

Potential triggers for chronic nausea and vomiting after appendectomy include:

• Recurrent or chronic appendicitis 3
• Abdominal wall abscess 4
• Anesthesia-related factors, such as the use of certain anesthetic agents 5, 6
• Surgical factors, such as the type of surgery and the presence of complications 2, 4