Severe Lower Abdominal Pain

My youngest sister is having severe lower abdominal pains.  She's had blood work (what type specifically) I don't know, ultrasound, endoscopy and MRI.  They looked at her appendix. She no longer has her gallbladder.  The pain seems to increase at night.  She has a history of seizure and has a vagal nerve implant from cyberonics.  She has seen a number of physicians who are unable to find anything.  They did locate a cyst on her ovaries, but stated that should not cause the severe pain.  She is now 23, but at age 3 she was diagnosed with a benign astrocytoma in her brain.  My mother lives in the ER with her.  They simply give her a strong pain med and send her home.  We are at our wits end.  She is on a series of anti-seziure meds, as well as, anit-depressants and now she's taking the pain medication.  PLEASE HELP US.  I've taken her to a large Atlanta practice who did nothing, they evalutated her reports, but no independent laboratory testing.  My family is in a small city and I just don't know what else to suggest or do.  The physicians locally are saying it's in her head.  I truly don't believe that.  This has been a issue for quite some time now.  I'm afraid she could be dying.  The strange thing is the pain subsides mostly in the day, but really kicks in the night.  She said it's painful to the touch when it's really hurting.  She's always at some level of pain even when she doesn't complain.  

Any help or suggestions or advice is greatly appreciated.

Thank You.

marik

[Kevin Pho, MD]

Tough to say without examination.  There has clearly been a comprehensive evaluation, including MRI, endoscopy (ensure that an upper and lower endoscopy has been performed), as well as a GYN examination looking at the ovaries.  

Things like irritable bowel disease is always possible in the face of normal tests, and certainly can be debilitating.  Medications like antispasmodic agents can be considered for treatment.  If there is an association with constipation, a medication known as Zelnorm may be helpful.  

As for the next step, another opinion with a gastroenterologist (preferably at a major academic medical center) can be considered for further evaluation.  

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

[yoshi]

i assume these doctors are ob/gyne??

[marik]

No.  She has met with a Ob/Gyn who did a pelvic.  This was maybe a year ago, or almost close.  She has seen Gastrologist and Internal Medicine and of course ER docs most recently.

[marley123]

I'm hoping this has already been checked for by your sisters OBG, but have they ruled out Endometriosis ??  I ask because I suffered years of unbearable pain that was blamed soley on my gastro problems, when in fact I had both issues going on at the same time.  

While I still suffer daily pain, it is not the totally debilitating pain I had before the endometriosis was dealt with.

Good luck to your sister, and tell her not to quit searching for answers.  It took me 4 years to find a Doctor that was willing to listen and look for the right answers, other than = "You're a woman, it all must be in your head."

[marik]

Thanks Marley. Hopefully she will have the laporoscopy Dec 8th.  I've thought about Endometriosis also.  I'll suggest that at the next appointment.  Please keep her in your prayers.

Mari