What are the recommended steps after an appendectomy (appendix removal) 18 days post-op, if I experience abdominal soreness after a traumatic incident?

Post-Appendectomy Abdominal Trauma at 18 Days

At 18 days post-appendectomy, after blunt abdominal trauma from being pushed, you should seek immediate medical evaluation to rule out surgical complications, particularly if there is persistent or worsening pain, as this timeframe falls within the critical period for detecting delayed complications.

Immediate Assessment Required

The primary concern is distinguishing between:

• Simple soft tissue soreness from the impact (most likely scenario)
• Surgical site complications including wound dehiscence, hematoma, or infection 1
• Intra-abdominal complications such as abscess formation or bowel injury 2, 3

You need clinical evaluation if any of the following are present:

• Persistent or worsening abdominal pain beyond 24-48 hours 2
• Fever, chills, or signs of infection 4
• Abdominal distension or rigidity 2
• Nausea, vomiting, or inability to tolerate oral intake 2
• Wound changes (redness, drainage, separation) 1, 4

Why This Matters at 18 Days Post-Op

The 18-day timeframe is significant because:

• Most complications from appendectomy occur within the first 3-5 days, but delayed complications can manifest up to several weeks post-operatively 2
• Wound healing has NOT achieved full tensile strength at 18 days—this requires 4-6 weeks 1
• The abdominal wall remains vulnerable to disruption from blunt trauma during this healing phase 1, 4
• If the original appendectomy was for complicated appendicitis (perforated, abscess, peritonitis), the risk of delayed complications is substantially higher 1, 4

Clinical Evaluation Should Include

Physical examination focusing on:

• Surgical site inspection for dehiscence or hematoma 1
• Peritoneal signs (rebound tenderness, guarding) suggesting intra-abdominal pathology 2
• Vital signs assessment for hemodynamic stability 2

Imaging considerations:

• If clinical examination is concerning or equivocal, contrast-enhanced CT scan of the abdomen/pelvis is indicated to identify occult injuries or complications 2
• CT is particularly important if there are signs suggesting intra-abdominal abscess, bowel injury, or ongoing bleeding 2

Management Algorithm

If examination and imaging are reassuring (simple contusion):

• Conservative management with observation 2
• Pain control with non-opioid analgesics when possible 2
• Activity restriction: avoid contact sports and heavy lifting for the full 4-6 week post-operative period 1, 4
• Return precautions: seek care if symptoms worsen or new symptoms develop 2

If complications are identified:

• Wound complications require extended activity restrictions and possible surgical intervention 1, 4
• Intra-abdominal abscess may require drainage (percutaneous or surgical) and antibiotics 2, 3
• Bowel injury or significant bleeding requires urgent surgical consultation 2

Critical Pitfall to Avoid

Do not assume that feeling "mostly recovered" at 18 days means the abdomen can tolerate contact activities. The standard 4-6 week restriction for return to contact sports exists because wound tensile strength is not fully restored until that time 1, 4. Returning to school is appropriate, but the child should avoid contact sports, rough play, and activities involving abdominal impact until cleared by the surgeon at the 4-6 week mark 1, 4.

When to Seek Emergency Care

Go to the emergency department immediately if:

• Severe or rapidly worsening abdominal pain 2
• Signs of shock (rapid heart rate, low blood pressure, confusion) 2
• Rigid, board-like abdomen 2
• Fever >38.5°C with abdominal pain 4
• Wound opening or visible separation 1