Severe Stomach Pain Attacks

[Lizzi]

I am a 65 yr old female and have been having severe attacks of excruciating lower abdomen pain that starts like gas pain, then gets harder (just like labor pains)then eventually to diarrhea & vomiting to dry heaving up a vile tasting dark green liquid (after all food substance is gone). I have had 6 of these attacks starting in late October, Jan, March, 2 in April and 1 this week each ending up in the E.R. with demoral & phenegran after x-rays & CT Scans.  In addition I've had two Small Bowel Follow-thru's, an MRI & MRPR(?) all showing nothing.  Although he suspects an intestinal blockage, no tests show one & since I have no gall bladder or appendix my gastro doc has stopped treating me because exploratory surgery is all he can offer. I didn't have that because the surgeon didn't really want to do that without something more conclusive to go on.  I have lost 18 pounds in 4 months due to not being able to eat for several days every time this occurs.  These attacks leave me very weak & sore afterward. I probably do have some scar tissue inside as I have had several surgeries in that area, an ovarian section, hysterectomy, and some scar tissue removed in 1998 (but no scar tissue shows on tests).  Could you please suggest anything that I might do?

[whitsend]

I have had numerous "attacks" which for now everyone refers to as Colitis attacks.  I have kept a food diary, activity diary, and whatnot to see if there is some kind of pattern to this un-imagineable episode(s).  I first begin to vomit and have diarreah, once I have vomitted everything in my stomach up, I start puking up bile (yellow) from my liver.  I have had X-ray after X-ray after X-ray, CAT scans, MRI's, upper GI's, colonoscopies, you name it-- I've been tested for it.  Results?
NOTHING.  Treatment - ER visit when I finally give up and admit there is nothing I can do.  If I have a good ER doc I will get some demerol/phenegran through IV or possible IM.  After all exrays and blood tests, and nothing found.  The ER doc calls my regular doctor and they admit me to the hospital for approximately 3-5 days, starting out with nothing by mouth, then water, then soft diet, then regular.  I have no appendix nor do I have my gallbladder anymore, but it sure seems funny that this all started AFTER removal of my gallbladder!!
Your guess is a good as my (and my doctor's)

[kelly1987]

Oh dear, I hate to even suggest this, but your symtoms sound so much like my mom's.  It's been several years ago now but she did exactly the same thing and they did every test they knew to do and found nothing.  Finally they did exploratory surgery and found a rare cancer of the small intestine causing the blockage.  Now I think they can do a lot more if it is caught early enough.  The tumors can be removed and chemo can prevent it from happening again.  We had no cancer in our family at all so we were not prepared.  Don't hesitate, be persistent!  Good luck!

[Lizzi]

What is an MRCP? That's scary that a test would cause pancreatis isn't it?  Since I have had a complete hysterectomy I do not think gynocological could be the cause. I have had the light down my throat and the colon scope but it was 6 months ago and not at the time of an attack.  It's been impossible to get a doctor to come & do any kind of a test at the exact time of an attack (busy w/appts, meetings, etc.) Intermittent bowel obstruction makes more sense than anything to me - but what to do about it since they never show up on an xray.
No, I do not have bloody stool.  Volvulus sounds really scary to me, I pray that isn't it.  I looked up on internet and it's very dangerous - even the surgery is dangerous and very hard to diagnose.
Thanks for the suggestions.  I'm very concerned about this because I get weaker and weaker each attack.
Lizzi

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation.  One test that wasn't mentioned was a colonoscopy.  This is a pretty comprehensive test looking at the lower GI tract, and should be included in the evaluation of lower abdominal pain (assuming the CT scans and MRIs were negative).  

If the colonoscopy is negative, you can consider looking at systems other than the GI tract.  One consideration would be a transvaginal ultrasound looking at the adnexal/ovarian areas for a possible gynecological cause.

You can discuss these options with your personal physician.

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

[ozark]

it sounds like you may have intermittent bowel obstruction since you vomit green material....thats usually a classic sign of obstruction.......it could be from adhesions or from maybe intermittent volvulus since you have severe pain......i would as the previous person stated go to the er immediately when it happens and hopefully an xray would prove somehting at the time of the attack  ...do you have any bloody stool? ....a volvulus is an emergency situation by the way if it stays........good luck

[GastroGal]

Hi,
Sorry for your difficulties.  Have you had any weight loss?  Go get an ERCP done?
GastroGal

[CARUU]

I've had very similar attacks.  The difference is mine starts in upper abdomen area and then follows as you described.  I've had and EGD and Colonoscopy recently.  I had ERCP a while back and it was inconclusive and caused pancreatitis.  Not fun.  I've had colon surgery, hysterectomy and gall bladder surgery.  Lot's of adhesions.  In my most recent discussion with my GI he suggested having a plan to get to the ER as soon as it happes again and get an xray of the abdomen to try and see what's going on.  He mentioned it could be adhesions causing a temp. bowel obstruction and that it could possibly mean surgery, but on the other hand more surgery can mean more adhesions.