help

[luckless]

I am four years out from a hysterectomy and small bowel resection for endometriosis involving the small and lg intestine. I have continued to suffer from RLQ pain since the surgery. Had a wound infection and dehisance and 2 incisional hernia repairs one with mesh secondary to the infection. I am ill every day with pain and diarrhea after meals. Had a colonoscopy 2 years ago showing ulcers throughout the lg intestine and in the ileium. Tentitive dx of crohns, bx not conclusive. Treated with multiple courses of steroids. I feel like the food does not empty from my stomach and then with great force by it moves through until it reaches the RLQ and then with intense cramping it get through and I get servere diarrhea. I have been to the ER a few times and had a CT which was neg. for bowel obstruction. Cannot tolerate any fiber, fruit or veggies. The CTs where done hours aafter symptoms appear. Could partial bowel obstruction be the cause of my problems, even with neg. CT?
My surgeon feels that surgery is too risky for bowel peferation with the mesh in place. GI doc wants to start Imuran. I sent my medical records to two endo specialists who recommend surgery to remove adhesions and look for more endo implants. What can I do? I have been suffering a long time. I have no comfirmed diagnosis and need some awnsers.

[Kevin Pho, MD]

Typically, a CT scan is pretty good for diagnosing small bowel obstruction.  If the results are non-revealing, you can consider further testing.  This can include a small bowel series or enteroclysis (where the duodenum is intubated and air and contrast are instilled directly into the small intestine).  These tests can be more sensitive than a CT scan.

Another option would be an ultrasound - however this isn't as sensitive as the CT scan.  

As for the conflicting recommendations, you may want to consider a referral to a major academic medical center for another opinion.  In difficult cases such as this, an academic medical center may have the experience that smaller hospitals lack.  

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.
http://www.straightfromthedoc.com

[luckless]

could Imodium cause the nausea that I am experiencing?

[JBay]

Poor thing - your symptoms sound so much like mine, which are due to abdominal adhesions.  Pretty much, unless you're fully obstructed, no test will pick them up.  I suspect that's what's causing your problems.  In the meantime, and since you've already had one doc advise against further surgery at this time, I suggest you find a really good pain management specialist.  Also, check on the internet for information on low residue diets.  Because of my adhesions, I spend most of life on a liquid diet.  Fiber is a definite No-No!  Best of luck to you in finding a solution.