Acute Abdominal Pain

[Ann Won]

1. Since a gallbladder surgery in Nov. 1999, my mother (80 years old) has been suffering acute abdominal pain which last 4-6 hours each time. The pain comes from one inch above the bellybutton to the right.

2. She has had numerous diagnoses (ERCP, colonoscopy wit polypectomy, CT scan chest, pelvis, abdomen, small ntestine, blood tests, etc) and doctors couldn't find anything wrong. Finally the pain management doctor said this is Neuroma without any tests such as MRI. They have prescribed Neurotin and Ultram for my mother since May 2001. Sometimes, Ultram cannot relieve the pain at all. The pain management doctor recently prescribed 'Prilosec' for her.

3. One of my internal medicine doctors said that my mother might have a 'muscle scar' from the surgery. This might be true because 'Blue Stuff' (a kind of herb cream) can relieve the pain for about 5 minutes.
My mother has serious congestive heart failure, high blood pressure, etc.

4. Because the current pain management doctors cannot do anything except for prescribing medicines, we are thinking to take different options. Please advise:
a) Could it be possible that my mother's abdominal tissue or nerve damaged when the medical instrument was inserted into the bellybutton in Nov.1999?
b) Does my mother have 'Neuroma' or 'muscle scar'?
c) What type of doctors (for example, pain management or neurologist, or other) has experience in treating this type of cute abdominal pain?

Would you please give their names and phone numbers in CA, if possible?

5. Thank you very much.

[Forum-M.D.-DT]

Thank you for visiting the family practice forum.

I have seen patients who have had a common bile duct stone which could cause symptoms similiar to what you describe. You mentioned she had an ERCP. If this was normal, a common bile duct stone is less likely, however if it has been a while since her last ERCP, this may be a test worth repeating.

It is quite possible that your mother has "adhesions" (like a scar on the inside) from the surgery. These adhesions can cause pain, and depending on the contents of the bowel near the adhesion, the pain may be very severe. Think about it, she has had surgery and now since the surgery has pain which lasts 4-6 hours and is in the same place. Keep a diary, I would bet that these episodes of pain may follow certain foods she eats and may occur at a regular "interval" after she eats. I suspect that when food is passing through the area of the small intestine where the adhesions may be ... that this is causing the pain. As the bowel tries to "push" the contents past the area where the adhesions are, she feels cramping and pain. Once the contents get past the area where the adhesions are, the pain resolves. Understand, I have never seen or examined her, but when you stop and think about it... the thought of adhesions and possibly a partial bowel obstruction makes sense.

Getting to part (b) of your question. Neurontin is very good for treatment of chronic pain and I would suspect this medication would be beneficial in the long run. Also, there are medications to help relieve "bowel spasms" (i.e. Levsin). I would talk to your doctor about trying this medication when she is getting an "episode".

(c) I suspect the best results here for her would be in the hands of a gastroenterologist or possibly a general surgeon. If you go to a Neurologist, you are likely going to just get more medication. If you go to the general surgeon, he/she may consider doing a "diagnostic laparoscopy" to go inside the abdomen to look for and "cut" any adhesions (scar tissue) which may be present.

I hope this information proves beneficial
Dean M. Tomasello, M.D.

[Maryjane]

Stomach ulcers are not uncommon in the elderly following the stress of surgery and are sometimes overlooked. Just giving medication for this might not be the solution. Stomach ulcers can present in wierd ways and cannot always be ruled out w/ the procedures and meds you mentioned.  I would see a new gastroenterologist.  (I am not a physician, I am a nurse who has had a patient with a similar presentation) Hope this helps.

[PipersMom]

My comment is for anyone suffering severe abdominal pain which is not relieved much and is prolonged.  I have abdominal adhesions and have had them since my surgery in March 1999 Hysterectomy, and Gallbladder removed and Lysis of Adhesions on bladder September 11, 2000.  Adhesions do not show up on any tests.  You must have laparoscopic exploratory done through belly button to confirm.  My symptoms are as follows.  Excruciating pain which is all over upper and lower abdomen.  Worst area is upper right quadrant, second is lower abdomen.  The pain sights are exactly where I had surgery, and adjoining sights.  The best relief I have had is Lorcet Plus for pain and the Super Blue Stuff.  If you are interested go to www.adhesions.org and see the link for www.adlap.com.  I will be having surgery in about 1-2 months by Dr. Gerhart, Dr. Reydan, and possibly Dr. Reich.  They are the best in the country and are located in Pennsylvania and New York.  I have been unable to find anyone anywhere that knows squat about removing adhesions without endangering your life tremendously.  Check out the testimonies on the adhesions quilt at the adhesions website.  Unfortunately, it was like reading my own story, but many horror stories of 10,20 or 30 surgeries.  I am 48 years at the time of this writing June 26, 2002.  I have a lot of years left prayerfully and I want to regain my life.  I have no quality of life at this time.  You are in my prayers for your Mom -- Ann Won.