Could this be Crohn's disease?

[gamy]

I have been having constant dull pain in my lower right ab for about a month. It began with what I thought was food poisoning with dyarhea. That seemed to have subsided. Then a few days later I experienced sharp pains in lower R Ab which lasted a few minutes off and on for a day. After that, I was left with constant ache. Have watery stools in the AM. Often can't get to the bathroom in time.The pain increases following BMs. There is a feeling of incomplete BM's. Sometimes pass only small, thin stools. Lots of passing of air. There is no blood but has been some mucous. The pain is reminiscent of my appendicitis 13 years ago. Appendectomy done then. I thought it might be an ovarian cyst (which I have had in the past. Left Oopherectomy done in 1986), so went to GYN who did trans-vag US, rectal exam and check for fecal occult. All were normal. Then had a ab/pelvic contrast CT scan. It was normal. It did show a few scattered diverticula of the distal colon w/o evidence for diverticulitis. I am seeing GI specialist on 5-10.
I had a flexible sigmoidoscopy in 1996 (because of right iliac fossa cramps) which showed a polypoid benign colonic mucosa with vascular congestion. Polyp was removed. Also showed mildly imflamed benign colonic muosa in sigmoid colon. Symptoms resolved.
I had a colonoscopy done in 2002, because I was over 50 yrs. Results were a normal colon exam to the cecum. There was a small prepyloric leiomyoma and a 2CM hiatal hernia, which I already knew I had.
I have been doing some research on Crohn's disease and am now quite worried. Also, I am wondering if the pain and problems are due to or complicated by possible adhesions from my 2 abdominal surgeries, namely the left oopherectomy and appendectomy. Also, could I have gotten some kind of intestinal bacterial infection, as I have not been checked for that. Please help me understand what is happening. I have a trip to HI Friday, that I now, feel I should cancel.

[Kevin Pho, MD]

With a normal abdominal CT scan, it is less likely that adhesions are causing the symptoms.  Crohn's disease is possible, and may not be seen during a colonoscopy.  You may want to consider small-bowel series for further evaluation.  There are some blood antibody tests that can also be considered if this diagnosis is suspected.  

If all the tests are negative, you may want to consider irritable bowel disease, which can cause these symptoms.  Treatment with increased fiber as well as anti-spasmodic agents can be considered if this is suspected.

You may want to discuss these options 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.

Kevin, M.D.
Medical Weblog:
kevinmd_b