Can a patient who has undergone an appendectomy (surgical removal of the appendix) experience burping and epigastric pain?

Post-Appendectomy Burping and Epigastric Pain

Yes, a patient who has undergone appendectomy can develop burping and epigastric pain, though these symptoms are not typical direct complications of the appendectomy itself and warrant investigation for alternative causes or post-surgical complications.

Common Post-Appendectomy Abdominal Complaints

Incidence and Nature of Late Symptoms

• Nonspecific abdominal pain is the most common late complaint after appendectomy, accounting for 45% of readmissions beyond 30 days post-surgery, with females representing 76% of this group 1
• Late readmissions for abdominal complaints occur in approximately 2.94% of patients during long-term follow-up (median 10 years), with females and those with complicated appendicitis or normal appendix pathology at higher risk 1
• The overall rate of small bowel obstruction following appendectomy is 2.8% over an average 4.1-year follow-up, or 0.0069 cases per person-year 2

Specific Post-Appendectomy Complications That Can Cause Upper Abdominal Symptoms

Adhesive Small Bowel Obstruction:

• Adhesions represent 55-75% of all small bowel obstruction cases and are a recognized complication following any abdominal surgery including appendectomy 3
• Having a history of previous abdominal surgery has 85% sensitivity and 78% specificity to predict adhesive small bowel obstruction 3
• Small bowel obstruction occurred in 1.24% of appendectomy patients and required surgical treatment in 0.68% 1
• Risk factors include perforated appendicitis (OR = 3.1) and midline incisions (OR = 5.4) 2

Stump Appendicitis:

• This rare complication can present with symptoms of acute appendicitis, ileus, or generalized peritonitis 4
• Surgeons should suspect stump appendicitis in patients with recurrent abdominal symptoms even years after appendectomy 4
• Abdominal CT is the gold standard for diagnosis 4

Why Burping and Epigastric Pain Are Atypical

Important Clinical Context

The symptoms described—burping and epigastric pain—are not characteristic presentations of typical post-appendectomy complications. These upper gastrointestinal symptoms suggest:

• Gastroesophageal reflux disease or gastritis (unrelated to appendectomy)
• Functional dyspepsia (unrelated to appendectomy)
• Aerophagia or gas-related symptoms (potentially related to postoperative ileus if acute)
• Small bowel obstruction with proximal symptoms (if accompanied by nausea, vomiting, inability to pass gas/stool) 3

Critical Red Flags Requiring Urgent Evaluation

If the patient has persistent symptoms, evaluate for:

• Tachycardia ≥110 bpm, fever ≥38°C, or tachypnea—these predict serious intra-abdominal pathology requiring prompt surgical exploration 3
• Inability to pass gas or stool for >2 days—suggests bowel obstruction 3
• Cramping/colicky pain—characteristic of mechanical obstruction 3
• Progressive abdominal distension, nausea, or vomiting—indicates possible obstruction 3

Recommended Diagnostic Approach

Initial Assessment

• Document the exact timing of symptoms relative to appendectomy (early vs. late postoperative period)
• Assess for signs of bowel obstruction: inability to pass gas/stool, abdominal distension, high-pitched bowel sounds 3
• Check vital signs carefully: tachycardia is the main alarming sign in the postoperative period 3

Imaging Strategy

• CT abdomen with oral and IV contrast is the preferred initial imaging for evaluating post-appendectomy abdominal complaints, with 88-94% sensitivity for identifying serious intra-abdominal pathology 3
• CT can identify adhesive obstruction, stump appendicitis, abscess, or alternative diagnoses 3, 4
• Do not delay CT imaging if clinical suspicion is high, even if symptoms seem nonspecific 3

Laboratory Evaluation

• Complete blood count (assess for leukocytosis suggesting infection or inflammation) 3
• Comprehensive metabolic panel (assess for electrolyte abnormalities from vomiting or obstruction) 3
• Consider inflammatory markers (CRP, ESR) if inflammatory process suspected 5

Common Pitfalls to Avoid

• Do not dismiss persistent or recurrent abdominal pain in post-appendectomy patients as purely functional without excluding organic pathology first 1
• Do not assume a previous appendectomy scar rules out stump appendicitis—this diagnosis should be considered in patients with recurrent right lower quadrant symptoms 4
• Do not delay imaging in patients with persistent symptoms and any systemic signs (fever, tachycardia, inability to tolerate oral intake) 3
• Recognize that females with complicated appendicitis or normal appendix pathology are at higher risk for late abdominal complaints requiring readmission 1

Management Based on Findings

If imaging reveals obstruction:

• Initial conservative management with NPO status, IV fluids, and nasogastric decompression for partial obstruction 3
• Surgical intervention required for complete obstruction, peritonitis, or failed conservative management 3

If imaging is negative but symptoms persist:

• Consider upper endoscopy to evaluate for gastroesophageal or gastric pathology causing upper abdominal symptoms
• Trial of proton pump inhibitor therapy for suspected reflux or gastritis
• Diagnostic laparoscopy may be warranted if symptoms are severe, persistent, and unexplained, particularly in post-surgical patients 5

If stump appendicitis is diagnosed:

• Surgical re-exploration and completion appendectomy is required 4