When people who have had infant surgery have a health concern in later life that could possibly be related to their initial condition, they are inclined to conclude that it is. In this post I want to say, it isn’t always like that.
An acquaintance of mine had pyloric stenosis (PS) and surgery as a baby, and recently had to return home from overseas because of stubborn stomach pain that the local doctor could not explain or treat. I suspected my friend might possibly be troubled by some after-effect of his PS history: after all, there are a few (in fact far too few) medical reports which find links between PS and several later bowel conditions. The very few reports I have managed to find may be read here, here and here. Interestingly, a German article claims that PS does not affect gastric functioning, a finding that intrigues me as the link between infant PS and later gastric ulcers is well established.
It is also a fact that after abdominal surgery adhesions are almost inevitable, that they can sometimes make life miserable, and that this is hard to remedy. The most common online complaints of PS survivors are about a long list of minor to major abdominal complaints, from mild discomfort and stomach sensitivity to chronic vomiting or pain, from fast metabolism to continuing reflux or GERD and hyperacidity.
But… my friend’s problem is apparently not related to his PS history. It has responded to extended antibiotic treatment, and an ultrasound showed it was a recurrence of his chronic diverticulitis, a common condition that occurs when small pouches develop in the colon and these become infected. I have not been able to find any mention of a link between PS and diverticulitis.
Digestion problems and abdominal cramps are in fact quite common. Here are some of what I have recently discovered –
- Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after their first exposure to gluten-containing products, pyloric stenosis sometimes being a factor.
- Older children may have more malabsorption-related problems and psycho-social problems.
- Adults generally have malabsorptive problems; people with mild coeliac disease may have symptoms that are much more subtle and occur in other organs than the bowel itself. It is also possible to have coeliac disease without any symptoms whatsoever. Many adults with subtle coeliac disease only have fatigue or anemia.
- Between 15 and 20% of the teenage and adult population suffers from the “Chronic Functional Abdominal Pain Syndrome” (or FAP, in other words, pain when the alimentary canal is functioning). There is a lot of material on the web about this, such as an article in a 1999 issue of the British Medical Journal’s Gut publication.
- Doctors are often advised that unless symptoms point to a clear and serious issue, it’s not sensible to try to diagnose the cause of complaints of abdominal discomfort and pain unless they have continued over more than a year.
As a result of learning this, I can understand even better that many people with a PS history and struggling with a range of abdominal problems may well find it hard to find a GP/MD or a GI specialist who will take their case seriously. Going by countless reports I have read online, most doctors will fob them off as just another FAP case, and dismiss that a PS or other infant surgery scar has anything to do with it. After all, most doctors and websites take the short-term and narrowly “medical case” line that PS has no long-term after effects. If a PS baby stops vomiting its doctors will close the case… and declare total and lifelong success.
It’s both sad and bad that the medical world does not realise that hardly any large and careful studies have been done on the relationship between infant surgery and later medical complaints – as evidenced by many years of web surfing! I have also been saddened by the number of medical journal reports which are too narrowly-based, poorly argued, and rather obviously (even to me a lay person) at odds with earlier reports – and apparently unaware of this. Also, far too many reports simply repeat a current fashion, such as the comparison between open and laparoscopic surgery.
I’m sorry if I sound cynical here, but 15 years of web research and correspondence with a few pediatric surgeons have taught and repeatedly confirmed all this for me.
Patients with an infant surgery past must realise any continuing problems may often be hard to diagnose accurately: we are complex creatures.
The medical community can and must do better in taking people who have survived infant surgery more seriously: we are complex creatures.