Abdomin - Lower right hand pain § discomfort

[WJW]

I am a white male - 34 age/6'1"/240 lbs. My problem arose approximately 1.25 years ago with pain in lower right side. Initially the pain was in the right side, but within several weeks the pain extended to middle of back - around right shoulder blade. As a result of this condition recieved colonoscopy to check for chrones, and multiple MRI's and scans - no chrones and colon looked good. Early CAT scan resulted in a diagnosis of apendicitus, which concluded in apendix removal in March-2003. (there was a delay in apendix surgey becasue the conlonoscopy found that the apendix appeared to be in good condition). Other tests performed before surgurey- CAT scan with injection-no problem, fecal testing for parasites-negative, x-ray with barium solution (look for chrones in upper small intestine-negative.  

Post surgery the pain has not resolved. Still have pain in lower right side and back, which has increased in magnitude slightly. I also have started experiencing mild occasional (1 time per week) pain on lower left side and horizontal disconfort below belly button (above pubic region). Pain increase during times of prolonged sitting. Pain is not 24/7-but experienced daily (more prevalent during mid-day and evening). Pain is not severe, but more like a constant ache (pain has never doubled me over). No associated fever.  Stool is not watery, and I have not had any weight loss-I have put on approximately 20 lbs during this 1.25 year period.  

When there is prolonged periods of pain, bowel movement and gas release seems to subside magnitude of pain. At these times, bowel movement appears to have mucus (clear jelly like substance-size of quarter) present. Bowel movement does not show blood.  

I am not sure if this conincidential, but have experienced anul fissures since original onsought of lower right side pain. Anul fissures looks more like a red rash that gest worse during times of increased right side & back pain.  

I look forward to your thoughts....

[Kevin Pho, MD]

You have been through a thorough evaluation including CT scans, MRIs, colonoscopy, even surgery to remove the appendix.  

Mucous in the stool may be indicative of chronic bowel infection such as shigella, colitis, or proctitis.  Make sure that the stool has been comprehensively cultured for bacteria, ova and parasites.  Stool tests for fecal leukocytes can also suggest a bowel infection.  

Malabsorption can also cause mucous in the stool - tests for fecal fat, lactose intolerance and blood tests for celiac disease should be considered.  

"Jelly" in the stool is associated with volvulus, intussusception or pseudo-obstruction.  Most cases can be found via CT scan and should be asked about when interpreting your films.  As I am not a surgeon, I cannot personally comment on these particular diseases.    

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.

Thanks,
Kevin, M.D.

[mahendra9]

A related discussion, Malabsorption and Pale Sunken Face was started.