Abdominal Pain

[homerroxy]

I had a vaginal hysterectomy May 2002. I sustained small bowel-injury.  Took 6 days to diagnose.  I had severe peritonitis.  I had a laparotomy with a small bowel re-section.  I developed numerous abdominal abscesses.  I had a wound infection.  I had a 30 day hospital stay.  I developed a fistula, but that healed on it's own.  I declined further surgery and fought abcesses with antibiotics.  Abcesses are now gone.  I have had terrible problems with constipation since this happened.  I now take Miralx daily and things are much better. My current main complaint is that I have abdominal pain mid-abdomen.  It feels like muscle damage or injury pain.  The pain increases with activity.  Whenever I get physically active (other than walking) it feels as if I have pulled all muscles ins stomach.  I have had this problem ongoing for 14 months.  I love to exercise, and used to work out 2 hours per day.  I can now only walk.

I developed 2 hernias after my surgeries.  1 left inguinal hernia (which was adjacent to wound infection area) and a small incisional hernia in my old c-section incison.  These hernias were unusual, but were most likely caused by the wound infection, and the laparotomy incision further weakening my old c-section incision.  I had surgery open hernia repair without use of mesh in December. Inguinal hernia on left has returned and is spreading to the right side (bi-lateral inguinal hernia now)  My doctor says it needs to be repaired again with a large mesh patch. My pain mid-abdomen does not seem to be related to hernia.  Dr. orderd an abdominal and pelvic CT scan.
1.  Within the pelvis there was a moderate amount of free fluid above the bladder.
2.  A cystic structure in the right adnexa measuring 4.5 CM was noted.
3.  In the peripancreatic region a low density structure is identified which appears to represent a conglomeration of nonopacified small bowel loops.

What does all this mean?  Do I have anything to worry about?  I did not have a cyst on my last CT scan 1 year ago.  I simply assumed my abdominal pain was either muscle damage or adhesions if nothing were to show up on CT scan.  I have not heard from my doctor yet, so I am assuming this report is no big deal.  But, I am very curios. What do you think?
Thank you!

[Kevin Pho, MD]

I would say that there are several non-emergent findings on the CT scan.  An ovarian cyst is a fluid-filled sac on the ovary.  Most are normal and occur as a consequence of ovulation.  They normally shrink after 1-3 months.  If you are menopausal, then an ultrasound should be considered to take a closer look at the cyst.    

Free fluid in the pelvis can be associated with internal injury, prior surgery or infection.  This may or may not be a benign finding.  It is hard to interpret this by itself - this should be correlated with the other findings that your physician is aware of.

The conglomeration of small bowel loops is a non-specific finding and is unlikely to be the cause of your abdominal discomfort.  

In general, I cannot see any acute findings on this report - I would however discuss it with your personal physician.      

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.