Abdominal Pain -- Filling Defects --- Need advice

[ChronicAbdPain]

Looking for help and advice regarding GI problems (?)  that have been an ongoing problem for the past 3 or 4 years....  I've had Nissera fundoplicaion for GERD, Hiatal Hernia Repair, mild gastritis, proctitis, and hemmorhoids... I also have Gastroparesis and just yesterday had a small bowel follow through that indicated liner and cylinderical defect filling of the ileum. Said an assessment for periciliac (or paraceliac -- not sure of the spelling). infection should be considered.  I've tried all kinds of medications... you name it, I've probably had it...  I've been hospitalized probably 5 times in the past three years for paralytic ileus.  I have acute onset of abdominal pain ever so often (about every 6 weeks lately) and end up having to go to the ER to get any relief.  Last week I did go to the doctor's office and he gave me some pain med which did manage to put an edge on it, but I still have pains and am very sore.  Gastroparesis was confirmed two years ago via Gastric Emptying study and also I swallowed that pill camera to study my small intestine, but it never went anywhere within it's time frame.  A CT of my abdomen and pelvis last week showed a cyst on the lower pole of the right kidney with a tiny calcium deposit in the wall.  Perhaps I'm wrong, but that doesn't sound like it would be the culprit of the severe acute abdominal pains that I get from time to time.  Besides GERD, Nissera Fundoplication, Gastroparesis and chronic paralytic ileus, I have HTN, Mitral Valve Prolapse, have had my gall bladder removed, a C-section, cyst on the lower collecting ole of the right kidney and total hysterectomy....

Is it likely that either the small bowel or renal cyst is causing the pain?

With my history as outline briefly above, what would the linear and cylindrical filling defect mean?  What is a periceliac infection?   Could these things be causing acute attacks of abdominal pain?  What can I expect for proper treatment?  meds?  surgery?  I've previously been advised to have surgery for gastroparesis or either get a gastric pacemaker . . . should I do that now?  would it help with the abdominal pain if it is coming from the small bowel? or do you even think the small bowel is the culprit of my pain?

[Kevin Pho, MD]

It could be possible that an infection or the chronic gastroparesis can cause the filling defect.  If infection is a possibility, an abdominal CT scan can be considered to see if there is any wall thickening or inflammation that may be suggestive of infection.  An infection can certainly cause or exacerbate abdominal pain.  

Regarding the chronic gastroparesis, the data on gastric pacemakers has best been effective in relieving symptoms of nausea and vomiting.  If pain is the predominant symptom of gastroparesis, the data for gastric pacemakers treating this is more shaky and not currently recommended.

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