Abdominal Bloating: acute onset

[nessi]

I am a 38 yr. old female in excellent health (height 5'6, wt. 150 lb). In 06/2000 I had an ovarian dermoid tumor removed from my left ovary. It was bigger than a grapefruit and was compressing on my rectum. Prior to the existence of the tumor, my bowel habits were normal (daily formed stool). While the tumor was growing, I had intermittent, severe abd. bloating, constipation, and intermittent LLQ abd pain. Since the tumor was removed, I only have watery stools (diarrhea x 4.5 yrs). I don't know if it that is a side effect of the surgery or the tumor. I have not had any issues with bloating until 3 weeks ago. I am now extremely bloated, no correlation to diet or whether I eat or not. My belly looks like I'm six mo. pregnant! I told my MD and she prescribed Aciphex and sit-ups. I think that's a chronic solution to an acute problem. After the MD visit last week, I began having low grade pain in my abd LLQ (same place as when I had pain with the tumor). The pain is dull, sometimes has a burning quality. It's intermittent and low on the pain scale (1 to 3 out of 10 max). I don't know what's happening, but this severe, sudden onset of bloating is very concerning to me. Based on what I experienced with the tumor, I am thinking the bloating may be caused by some sort of compression on the bowel (adhesion?, another tumor?). I understand that dermoids do not typically reoccur, but it is possible I have another type, such as a cyst or CA. If I were your patient, what would you want to rule out, and what test would you do? What do you think could be causing my symptoms?

[Kevin Pho, MD]

Sudden abdominal distention in the setting of ovarian cancer should be evaluated for ascities - and an ultrasound can be considered to evaluate this.  

In addition to the possibilities you have mentioned, colitis, diverticulitis, inflammatory bowel disease, or a mass, can all be considered.  A CT scan and colonoscopy (if the CT scan is negative) are reasonable options to workup your symptoms.

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

[surgeon]

Well, I wouldn't be suggesting situps as treatment. I'd start with a plain xray of the belly to see if there's gas, and if so, whether it's in the small intestine or the colon. Your list of possibilities is a good one: it could be adhesions causing a partial obstruction, it's not impossible that it's recurrance. If the plain films suggest partial obstruction, either of small bowel or colon, I'd send you to a general surgeon. If the plain films looked ok, I'd think about getting a CT scan.