Diverticulitis or what???

[Kathi Kimmerle]

I'm a 39-year-old female in general good health. I went to the ER with severe lower abdominal pain a couple of days ago, and was sent home after an xray & ct scan revealed "negative" studies. (An area of diverticulosis was noted, although no diverticulitis was seen. I did have an attack of diverticulitis about six months ago, and my symptoms this time were the same - severe stomach pain, fever, nausea & diarrhea.)

I had an "open" appendectomy six months ago, and a lap for endo about 3 months ago. I  also had an abdominal hysterectomy four years ago, and had my gallbladder removed two years ago. I still have my right ovary, and it appears to be functioning normally, although it does produce a high number of cysts each month, which are monitored closely.

The gastro doc that I saw today thinks my pain could be gyno related. However, he also said that I may need a barium study and a surgical consult for a partial bowel obstruction. If this were the case, wouldn't it have shown up on the xray or ct scan? Additionally, if it were gyno related wouldn't that have shown up also?

The pain I'm having is in my lower abdominal area below my belly button. It sort of radiates from left to right. All my labs are normal. What in the world is going on here??? Any ideas???

Thanks,
Desperate

[Kathi Kimmerle]

As it turns out, my ovary is bad, and I probably have intestinal endometriosis. (I consulted with a gyn.) I will be having an operation to remove my ovary and "clean out" the intestinal endo. My gyno said he'll be doing the surgery, but doesn't a general surgeon need to be there also for the intestinal part? Also, I have to have the surgery the "open" way with a belly button incision. What will this entail? Is this major surgery? If so, what's the recovery period? A little scared here...

[Kevin Pho, MD]

It is true that obstruction should be seen on the CT scan, but this is not a 100% accurate test.  I would suggest a colonoscopy as the next test to evaluate the lower abdominal pain.  This would be more accurate than a barium study.  Irritable bowel syndrome as well as inflammatory bowel disease are other considerations.  

GYN causes also may not be seen on the CT scan.  A transvaginal ultrasound would give better imaging of the ovaries and uterus to  further evaluate the symptoms.  Surgery would be considered if the aforementioned tests remained negative.  

I would investigate the possibility of a colonoscopy and consider a GYN referral.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Kathi Kimmerle]

Forgot to ask: What are the symptoms of intestinal endometriosis?