Puzzled by pain

42 male non-smoker, occasional moderate drinker, healthy with a hiatal hernia diagnosed in 2000 and since then monitored through biannual endoscopy (last was summer 2003) and treated on and off with omeprazole or rabeprazole sodium. In the beginning of 2004 I have developed generalized pain in the lower right quadrant of my abdomen. Pain is never unbearable and it manifests sometimes as a superficial cramp, sometimes just as discomfort. It also appears in the right lower back, especially at night. More recently, it has appeared at the top right corner of the ilium, also extending into my groin area. It is not triggered by movement, although if I stretch my right side, I feel some discomfort. Also when I exercise I do not feel any pain and I am not limited in any movement. During 2004 I underwent ultrasound, colonoscopy, and cat scan. Results were all negative. Also I had several visits with two different gastroenterologists who did not find anything abnormal. . Blood tests results were also normal. At this point I am not sure what to do next and how to understand and eliminate the source of my pain. Should I repeat any of the tests? Should I see a different specialist? An orthopedist? a nephrologist? A urologist?

[Kevin Pho, MD]

A colonoscopy and CT scan would be the best tests to evaluate pain the in the lower right quadrant.  Things like diverticulitis, colitis, inflammatory bowel disease or colon masses would be ruled out with these tests.  

With the pain radiating to the back, you may want to examine the kidneys - with a pelvic CT scan (looking for stones).  A kidney ultrasound can also be considered.  These options can be discussed with a urologist.

If negative, then irritable bowel syndrome can be considered - and treatment optimized, perhaps with antispasmodic agents.

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