Possible pathogenetic roles of abdominal surgery in irritable bowel syndrome

Recently, a plethora of studies have reported that irritably bowel syndrome (IBS) patients have increased incidences of abdominal surgeries, mainly gut surgeries. This high incidence of surgeries highlights the fact that the surgery was done because diagnosis of IBS was not suspected in them. It is then a matter of inquisitiveness as to why the diagnosis of IBS was missed in so many patients. Lack of clinical diagnostic sophistication could be one of the reasons. However, inspite of these facts, it has never been documented that the typical IBS like picture was present in these patients before surgery. Mostly, the preoperative complaints in negative appendectomy patients have been atypical pain syndromes. Thus we should also take into account the possibility that the typical IBS symptom profile was not present in these patients before surgery and that the surgical intervention could have resulted in subsequent development of complete picture of IBS. Infact, in one study, various surgical procedures were known to precede IBS symptoms, where they have also been conceptualized as one of the stressors which could lead to IB. Seeing from the other perspective, the etiological understanding of IBS in medical literature is still so preliminary that we have only been able to enumerate some possible factors. In such a scenario, we need to explore in detail the events which occur frequently in IBS patients, like abdominal surgery. Here, we hypothesize that any abdominal surgical intervention could itself be a reason for development of IBS. We provide evidences from literature in favor of two such possible mechanisms through which any abdominal surgical procedure could act resulting in development of IBS. In addition, we present the report of follow-up of 4 of our own patients where we specifically inquired about IBS before the appendectomy, which turned out to be negative. After 6 months of the followup, the patients developed symptoms which were diagnosable as IBS. (C) 2010 Elsevier Ltd. All rights reserved.