Chronic RLQ pain

Hello, I'm a 31 yr.old female with chronic RLQ pain.  I've had it for over a year now.  It used to just come and go, but now it's a daily occurence.  I had my gallbladder removed in May 2004 as it was not functioning.  I've had numerous CT scans, ultrasounds, blood test, upper GI with SBFT (April 2004), colonoscopy (Aug. 2004), and all have been normal.  My GI reached the distal 3 cm of the ileum and that appeared normal as well.  No biopsies were taken during the colonscopy.  In November 2004 I had my right ovary, fallopian tube and appendix removed laparoscopically.  I still have the pain!  The appendix was blocked on the inside, so they said it was good that I had it taken out.  I had 4 pain free days last week and that was it.  I sometimes get nausea as well as the pain. I have had no weight loss or fevers.  I am concerned about Crohn's though, because my pain is exactly where the terminal ileum is.  My pain seems to get better if I lay off of food.  Should I go back to see my GI?  He tried Bentyl with me in case it was IBS, but that had no effect on the pain.  Any advice would be greatly appreciated. Should I request another upper GI with SBFT since my last one was in April 2004?  Thanks

[Kevin Pho, MD]

There already has been a pretty comprehensive evaluation.  Things like appendicitis and gallbladder/liver disease have been evaluated for with the CT scan and ultrasound respectively.  

Irritable bowel disease and Crohn's disease can still be considered.  The small bowel can be difficult to image - the SBFT would be the most reasonable first step.  There are some experimental studies with capsule endoscopy which some studies say can adequately image the small bowel for Crohn's disease.

If negative, you can optimize treatment for irritable bowel disease - smaller studies have had success with tricyclic antidepresants.  If there is a constipation-predominant component, medications like Zelnorm can be considered.

These options can be discussed with your GI doc.

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.
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