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Low Grade Fever Right Abdominal Pain
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Low Grade Fever Right Abdominal Pain

Any advice would be exceptional as this problem has me walking around with a towel belted around my mid section as this provides some relief. I have been in and out of the ER several times from the pain in my lower right abdomen. All blood work has come back normal CT scan without contrast showed nothing out of the norm and yet this pain continues. I have had hernia checks all saying no hernia. It feels like some one is sticking a needle into my intestines. The pain is not overwhelming in any way just a constant ***** feeling with some pressure. I have also had constipation for weeks now with no urge to have a bowel movement but upon trying I make small progress. I have recently gone now from ER to a clinic and I am currently being told I have IBS and have been prescribed Dicyclomine which is generic for bentyle. This helps mildly but seems to be loosing it's affect. I have recently turned in Stool samples for blood culture but have not yet received the results. My concern is that It is being accompanied by a low grade fever fluctuating from 99.0 f to 99.8 and at other times perfectly normal. From my studies of IBS fevers are not associated with it. Today I have had 6 small bowel movements each more loose and the last Diarrhea. I have also been having night sweats on occasion. Stress and any extended amount of physical activity makes the pain worse. If I remain in bed without moving for a day it almost goes completely away but returns soon after moving around again. There is no pain to the the touch pushing my abdomen. But when I lean back and away from the pain I feel what could best be described as a tearing feeling, when I lean Into it the pinch worsens. Sometimes the pain will spread to a spot behind my right mid ribs. This has been going on for over a month now and is slowly making me want to just give up on life. I would prefer sever pain to this nagging pinch and pressure. Any Ideas? Is it just IBS?
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Avatar_m_tn
Doing more research on the matter  i find my symptoms resemble Clostridium Difficile Colitis. I have taken large amounts of non prescription Amoxicillin over the last few years due to abscesses in my teeth and lack of dental insurance. I'm going to give some Pro-biotics and Yogurt a try and see if it helps. I am still open to any suggestions though. Thanx again.
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Avatar_m_tn
Clostridium difficile usually causes colitis in the left (descending) colon, and it can be diagnosed with stool Cl-diff toxin test. There's no phylosophy here.

This is not IBS.

Right lower abdominal pain + temperature + loose stools + night sweats may be from:
- appendicitis (Dx: CT)
- Crohn's disease which typically causes inflammation of the last part of small intestine, just before appendix (Dx: colonoscopy, or upper endoscopy with duodenal biopsy)
- carcinoid tumor (Dx: 5-HIAA in urine, elevated blood serotonin)
- lymphoma (would go with enlarged lymph nodes somewher in the body, what can be checked by body examination and CT of abdomen, Dx: biopsy of enlarged lymph node or biopsy of small intestine during double baloon enteroscopy)
- tuberculosis of small intestine (+ tuberculosis of lung Dx: chest x-ray)
- endometriosis (if you're woman, Dx: laparoscopy)
- uretheral stone (would go with burning at urination, Dx: urine test for stones)

Where to start?
1.a. "WBC stool" (leukocytes in stool) or "stool lactoferrin"  test show, if there is inflammation in your intestine or not.
1.b. Clostridium difficile toxin in stool
2. 5-HIAA in urine for carcinoid, also other urine tests, if stone is suspected.
3. X-ray of the chest, if the pain is *behind* ribs. If pressure on ribs causes pain, this is probably costochondritis.

Next, if needed:
Colonoscopy, blood test for tuberculosis, laparoscopy for endometriosis.

Tests are done one after one, so no need to be overwhelmed with my suggestions.

Can you say more precisely, where exactly is the pain? Use navel, ribs. and right hip as orientation?
How old are you?

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Avatar_m_tn
I'm a 29 year old male to answer those questions.
I have been giving chest and abdominal X-rays several times over a period of 4-6 weeks all of which returned normal results.
I have had one CT abdominal scan also returning normal results. No swelling or blockage of any kind.
Appendicitis has been ruled out by several physician exams. All from lack of abdominal pressure pain, lack of rebound tenderness, normal white blood cell count, Urinalysis, X-ray and CT scan.
Lymphoma ruled out due to no enlarged Lymphs from body exam and CT scan.
Endometriosis obviously ruled out since I'm not a woman.
Tuberculosis ruled out By TB test coming back negative.
Uretheral stones rules out by Urinalysis and CT scan.
Carcinoid tumor, unsure. I have had about 20 urine tests and i swear like 100 blood tests done. Is this something they would look for in an ER testing situation.
Crohn's disease. I have suspected this myself. I believe a colonscopy is in my current physicians near plans. She is currently awaiting the results of my stool cards and some additional blood work before going any further in the matter. In the mean time I am to suffer idly by.
I have also suspected a possible femoral hernia or abdominal abscess, But I'm personally unsure if a CT abdominal scan would show this or not, especially without being given contrast.
Again when pressure is applied to the spot there is no pain making it difficult to pin point, But I would say 1&1/2 to 2 inches directly to the right of my belly button. If I come down 3 inches from this spot I find what feels like a trapped gas pocket. For lack of a better definition when I push here I get a gurgle feeling and can here it. This gives momentary relief, But again no pain tenderness or rebound.
I'm becoming concerned for my life with all this time going by without any definite answers and my first child on the way. Now over the course of last night I have gone from severe constipation for over a week to 7 bowel movements, each becoming more loose to full diarrhea and had to struggle to even get the loose stools to pass. You seem to know your stuff so I look forward to any additional info you can offer. If I can give any other helpful details please let me know.

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Avatar_m_tn
"Trapped gas pocket", the location and description, correlates well with abdominal hernia, or inguinal hernia, or whatever is its exact name. Any doctor checked this? I think such a hernia wouldn't show on any investigation, since it is actually only a bulging small intestine, and usual contrast investigations don't reach it.

I'm not sure if constipation, diarrhea and especially night sweats can be related to hernia, anyway, if you solve this, you will see which symptoms will remain.

Urine test for carcinoid tumor has to be ordered separately, this is not a routine test. Now, this is maybe not the first thing to do. You might want to have stool test for Clostridium difficile toxin. And stool culture test and test for parasites. Before colonoscopy you may also have stool lactoferrin test. Lactoferrin is a protein released from leukocytes and it speaks for intestinal inflammation, like Crohn's disease. Gastroenterologist should say if this makes sense.
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Avatar_m_tn
Meckel's diverticulum is another possibility. This is a pouch in small intestinal wall, which, instead of normal intestinal mucosa, is covered by abnormal gastric mucosa. This may cause ulcer and intestinal bleeding. Diagnosis is with capsule endoscopy or double ballon enteroscopy, and if it bleeds, the site of bleeding may be found with a help of a contrast substance injected into a vein, and leaking out into intestine, what is seen on x-ray or CT I think. The first test is Hemoccult, but it may be negative, since bleeding don't allways occur.
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Avatar_m_tn
Well after mt last post the pain move abruptly to my upper abdomen right under my heart causing severe pain and shortness of breath. Me being the worry wart I am ran right back to the ER. I finally got a doctor who had seen me before so he knew what I had experienced in the past and what I was experiencing now. He ordered a contrasted CT and X-ray of the abdomen as well as more blood work, and on your advice I requested a carcinoid tumor test. Clean as a whistle. It appears I do have severe IBS on top of a peptic Ulcer and an Ulceration of the large Intestine. After stuffing about 4 pills down my throat and giving me a scrip for each I went home 4 hours later feeling better than I have in over a month. I have set up a colonscopy with my primary in 10 days to rule out anything else. After taking this medication that gas pocket I mentioned came freely out unfortunately as I bid gooday to my pretty nurse. So alas I left feeling fine but rather red in the face. Ulcers and IBS togeether cover all my symptoms. Thank you for your advise and the care to help a stranger try to figure out a personal problem. Many Blessings.
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