Massive Upper Abdominal Pain With No Other Symptoms Or Triggers

[DigitalMan]

For over two years now my wife (now 34) has been having “attacks” of massive upper abdominal pain. We’ve seen so many doctors and had so many tests, but none have found the source of the pain. The pain is all around the front just under the ribcage and radiates around the back. It’s like an inch or two wide ring of pain. The pain comes and goes, but she usually has at least a minor attack every day. The attacks last from a few minutes to 17 hours. She describes the pain as “vice-like”, meaning it’s someone is tightening a vice around one of her organs. Every few months the pain gets just terrible and we make a trip to the ER. She has given birth to our 3 children without any painkillers and says this pain gets way worse than childbirth. The strange part about hers, which seems to differ from lots of posts I have read, is that there are no other symptoms and no triggers that we can identify. The ONLY symptom is massive pain. There is no diarrhea or nausea most of the time (only twice ever, probably a coincidence). The attacks seem totally random as far as we can tell. They don’t appear to be caused by diet (hers is low fat anyway) or anything else we can identify. The only pattern is that the attacks seem to occur most frequently around 4am. She has had tons of tests and they haven’t revealed the source of the pain.

(post continued in reply)

[DigitalMan]

(continued from my original post)

The pain started while she was pregnant with our 3rd child and they thought it was just heartburn. A few weeks after delivery she had her first real bad attack and we took her to the ER (first of many trips). They said they saw gallstones, and that sure seemed like a likely cause for her symptoms so they took out her gall bladder. Well as you guessed, that didn’t make any difference. Nothing seems to relieve the pain, however balling up in a fetal position with her knees down and her back up feels a little better than laying on her back or side when she is having pain. Also when they give her morphine in the ER, it seems to make the pain worse, not better. Since then we have had the following tests:

1) 2 ERCPs, one with a Sphincter Of Odimenometry. Both gave her massive pancreatitus (pancreatitis) and the pain felt exactly the same (however other times she has attacks the blood tests don’t show pancreatitus (pancreatitis)). Sphinter Of Odimenometry came back showing no problems, but the DR couldn’t get everywhere he needed to to test the pressures so this is still a small possibility, but they said we should never do that again because it caused the severe pancreatitis
2) 2 upper and lower GI cat scans
3) MRI
4) Endoscopy
5) Colonoscopy
6) Abdominal ultrasound
7) Kidney ultrasound (showed a slight calcification, but DR didn’t think it’s the cause of the pain)
8) IVP
9) EKG
10) Blood tests (showed she was slightly anemic)
11) Urinalysis
12) Stool sample
13) 2 chest x-rays
14) Allergy testing
15) Anti-Nuclear Antibody (ANA) test with results of 1/640, which is abnormally high. We are seeing a Rhumatologist now to see if it could be a connective tissue disorder like Lupus, but he said pain this severe is not usually associated with those type of diseases.

Here is a list of medications and other things we’ve tried:
1) Demerol (does nothing for the pain)
2) Percoset
3) Antacids
4) Zantac / acid inhibitor
5) GI cocktails (pain got better one time after taking one, but other times it didn’t help)
6) Levsin
7) Carafate
8) Papaya Enzyme
9) Celebrex
10) Zoloft
11) Allegra
12) Neurontin
13) Some medicine for a spastic colon
14) Sleeping upright
15) Waking up to urinate before bladder fills to much
16) Morphine (we think it may make the pain worse)
17) Vioxx
18) Ativan (last time in the ER about 20 minutes after she took this, the pain got much better. She had also just taken a GI cocktail. We don’t know of either of these helped or it was a coincidence. We’ll try again next time in the ER.

Does anyone have any clues what this could be? Any suggestions on tests to ask for? Any suggestions on anything to try to relieve the pain?

Thanks very much for your help,
Guy Kendall (guy.***@****)

[aniee1]

I am having the same problems. I had bloodwork done, CT Scans, Ultrasound of my Liver and Pancreas....all normal.  My gallbladder was taken out 20 years ago, but it is the same kind of pain. I cannot tolerate any fatty foods. My pain is under my right rib cage and radiates to my back. It does feel like a vice-grip and also a feeling of a sock rolled up under my ribs. My pain is always there now..not always severe but constant. My gastrologist and surgeon I saw have no clue. I am just about ready to give up and just try to live with it.  My family doctor has suggested that I get tested for Lupus also. I have had this pain for about 10 months now and I can understand what your wife is going through...if we just knew what caused it, maybe we could deal with it. About 6 weeks ago, I developed on rash on my face that lasted for 3 weeks....maybe I should be tested for lupus but I'm so tired of being poked at and told that they can't find anything wrong.....Keep posting please...maybe one of us will find out just want is happening.........Aniee1

[Lor]

The pain you discribe is the same as I have or now had. First my question is what part of the country do you live in? Does your wife seem to have stronger attacks right before or during her period? Does the pain ease with eating or does it get worse?

I had the same attacks you discribe for a number of years. My first one was when I was 16 (I'm 36)they came on and off every 3 months or so for many years. Then one day they just kept coming and didn't end until last week. In my case I always got them at night. At first it felt like alot of gas pressure. I'd get up walk around they would go away. The pain has been it's worst just these past 2 years. They'd start sometime during the night and sometimes wouldn't go away until lunch time.  The pain was always in the same spot right under the sturmun and radiate to the back - sometimes the back pain was just as bad.
I just recently found a Dr after several - who knew when I walked in what was wrong. The opening to my bile duct didn't open enough to let the bile out, so for years it backed up into my gallbladder. Then my gallbladder failed and had to go. When the gallbladder wasn't there to take the back up my liver started showing signs of problems then my pancreas. I was in so much pain and not one of the Drs would even concider the bile duct. They all just threw their hands up and said no can't be that. Well it was and last week I had the surgery to fix it and haven't had pain since. I really feel like a new person.

[aniee1]

How did they find out it was your bile duct? What kind of test did they perform.. I have thought about that maybe this was the problem, since I can't seem to digest anything with fat in it. I finally found this out just by trial and error.. I had a hamburger one night..got servere pain, an egg salad sandwich one night....same pain..and then I ate 1/2 sub and thought I was going to end up in the ER.  Since I had my gallbladder taken out years ago, I guess no one thought of the bile duct. But it makes sense to me. It is the same kind of pain I had when I was having my gallbladder attacks..I am now on a extremely low fat diet..I haven't had a bad attack since I have done this but the pain is still present on a constant basis...just not servere. I see my gastrologist on Monday and I'm going to mention this to him. Wish me luck and thank you.. And again , what test did the Doctors perform in order to give you this diagnosis?

[DigitalMan]

lor and aniee1: Thanks for your replies. Here are the answers to you questions. We live in Colorado. The attacks don't seem to have any relationship to the time of her period as far as we can tell. Eating does not seem to have any affect on her pain. Doesn't make it better or worse as far as we can tell. She doesn't eat many fatty foods, but that doesn't seem to cause her pain either. She doesn't usually get nausea or diahrea with the pain. That is where her situation seems to differ from most of the people I've read about here. Nothing that we can identify seems to cause the pain to occur and she doesn't have any other symptoms besides the pain. It just comes and goes randomly (well, I'm sure there is a cause, we just can't identify it). That is part of what is making it so hard to diagnose. Lor, I'm glad to hear they were able to relieve your pain. It seems so many people here are un-diagnosed, so it's encouraging to hear that they figured someone's problem out.

Guy

[Lor]

I ask these quuestions because nobody seems to think of these. A lot of women have problems with their mentrual cycle. Something to do with the hormones. I know some of my worst attacks were during this time. Also eating for me helped to relieve the pain. I guess it stimutated my bile duct enough to open and let some bile out. Which eased the pain. I know many of the people who post on this website are anti ERCP with menometry because of the risk involved. The risk to me was worth it. The problem with it is there are very few Drs who have done it enough to know what they are doing. I live near Florida. I found the Borland groover clinic seaching for answers. The sad part of my ordeal is I knew what was wrong with me a year ago, but convincing Drs of it was impossible. When I saw the last Dr at the clinic I had put aside what I thought it was Because the 4 before were so into reflux or ulcers. When he told me it was my bile duct - It was encouraging to know finally someone will look at that. They did tell me there are only about 5 hospitals in the country they would recommend for ERCP with menometry. If your willing to travel its worth researching.

[aniee1]

I live in Georgia. I, too, have no nausea or diahrea. Is it possible that during your wive's gallbladder surgery , the bile duct was injured? I have heard this is a possibilty.  I know this may sound cruel, but if she would eat a meal with fat, I wonder what would happen.  I have less than 15 grams a fat a day now and that is very little. I remember my first gallbladder attack happened in the middle of the night after I ate a hot dog for dinner.  If I could only make my gastrologist understand the pain is the same except there is no vomitting or fever associated with it now. I am in Menopause. Had a hysterecomy 5 years ago.  lor, what test do they preform to check out the bile duct? Or is the only way is to have exploratory surgery?.....They saw nothing abnormal on my CT Scan.....Aniee1

[Lor]

I had an ERCP with menometry. This is where they measure the pressure in the bile duct. Ask your Dr about Sphincter of oddi disfunction. I asked one Dr last year he about laughed me out of the office. This condition will mimic a gallbladder attack. I found mine to be more severe than the gallbladder attacks.
If you live in Georgia (I do) I really would suggest the Borland Groover Clinic in Jacksonville. Even if SOD isn't what you have. I'm sure would be able to help you. Look them up at borland-groover.com  I have military insurance and they were able to work with me. They'd jump over hoops to help.

[Richelle]

Please someone help me with upper abdominal pain

I have severe upper abdominal pain that comes and goes but when i have it it radiates to my back.  I went in emergency last week they just did blood tests gave me dilaudid and sent me home.  It is back and i get alot of gas bubbling in my stomach at night all night long and it burns when i have to go potty.  

I did wake up last week in the middle of the night with acid in my throat but i have no burning in my esophagus.

I dont have medical insurance but have to go back to get tests done.  Does anyone have these symptoms.  Upper stomach sore to the touch, hurts alot, i have diahrea with any fatty foods i eat immediately and it burns.  All bowel movements burn like there is acid in them.  I have severe pain in my upper tummy like somone punched me, it hurts to breathe.

Is this my gallbladder? what kind of tests do i need.  I am so scared now cause this is getting worse.

The pain is so severe i cannot stand it.  I am taking maalox and tagamet but it does not good.

Doctors at the hospital said blood tests were normal and sent me home but i am in severe pain and can hardly eat anything that doesent make me have diahrea.

Please any suggestions, i need help with this one.  I am scared

[aniee1]

I'm sorry you are in so much pain. When you read these posts you'll see that we are all in pain with no clue as to why. The only thing that has helped me is an extremely low fat diet, no red meats at all...eatting smaller meals more often and drinking plenty of water. I'm losing weight doing this but it is better than being in servere pain and doubling over the couch to try to relieve some of it.  My pain is still there but not as bad as it was...and when the attacks were the worse, it was when I had eatten something with a high fat content. My gallbladder was taken out years ago and all the tests so far has been negitive. Hang in there and try to find a community hospital where they will take you if you find yourself in too much pain. You can't just suffer like that........Keep Posting!! Aniee

[elaine71]

My 11 year old daughter is having exremely bad stomach pain.  She has been having this pain for about a year now.  Last week she was so bad on a sunday that we had to take her to the emergency room?  They said she had the stomach flu, i did not agree.  Her pain was very low and too the sides so we thought maybe apendix, but they did a blood test and her white count was normal so this was ruled out also her pain was not consistent with apendix pain.  We have been told by our doctor that she has a very sensitive bowel?  What is this supposed to mean?  I insisted that we take her to a specilist and so we are going to primary childrens hospital in June! That was the first appoint i could get and we are only going there because i insisted!  We are trying to watch what she eats and see if anything triggers it.  She has not even started her period yet so it cannot be that.  any suggestions?

[Lor]

why couldn't it be her ovaries? I think they start working almost a year before a period starts. I've had 2 ovarian cysts. One didn't hurt the other hurt like crazy and went into my lower back. Childrens Hospital is a good place to go. Don't rule this out just yet.

[busybettybooper]

I started having this pain 2 years ago.  The first time it happened I thought I was dying.  I couldn't walk or move for 3 days. It started with an ache in my right side and seemed to go into my back.  The first doctor said pleurisy and put me on medication. That was May 2000.  I have had the same thing every three or 4 months ever since.  Sometimes I can't talk the pain is so bad.  I take Flexeril and Vicodin every 5 hours just to get through it.  I just had an attack this past weekend but I had  one 3 weeks ago and now I am really worried it's getting worse.  I've been to hospitals had MRI, CAT scan, Bone scan and found nothing. I've been to Orthapedics and Neurosurgeons.  I thought it was in my spine but now I am starting to wonder.  I  have pain that I live with on a daily basis that seems to be in my side and mid back.  When I go to bed and lie still no pain but as soon as I move it's there.  I even have the sensation that something inside moves when I first lie down and then it settles down and I can rest.  But every time I move it hurts.  I am female and 48.  I've had a partial hysterectomy in 94.  I have been a dieter most of my life but my gallbladder looked good when they checked it.  I have lost 25 pounds hoping that would help but it hasn't. I am determined to find out what this is.

[aniee1]

Hi, Well I went to my Gastro Doc on Monday and his theory is IBS. I know this is a catch-all term but so far that is all I have to work with. My liver stats were normal,so he does not believe that my inability to digest fats is caused by that organ. When we laymen see a diagram of a gastro tract, we see everything separate...the colon is in plain sight but that is not what it is like in our bodies. My Doc explained that all the organs are bunched together. There are no spaces. So our colon and small intestions actually partly sit under our liver, pancreas, stomach, etc. Even when we sit down our colon can actually move under our ribcage. So if we have a problem with a certain food and bloat with gas we can feel something bubbling inside, like its moving or the feeling like a knot or rolled-up sock...IBS can cause pain anywhere in the colon not just the lower right quadrant.  Stress and foods (sometimes greens like salad)can be the problem or really any other food...it is just takes trial and error to find the culprit.  I am not saying that IBS is my problem or yours, hey but it is worth investigating. I am tired of all the tests and poking only to find out nothing is wrong and that I shouldn't be in pain.  All I know is that since I have started to elimate all fatty foods from my diet, I have not bloated at all.....now if I could relieve all the stress of daily life.......yeah, right!  
My pain is still there under my ribs but not servere. I do not eat anything after 8 o'clock at night and only sip on water if thirsty..That way my digestive tract gets a rest and hopefully there will be no more early morning attacks......I'll keep posting and let you know how I'm doing...........Aniee
e.....yeah, right!

[Lor]

I was told by a couple of Drs that my problem was IBS also. I could never believe that. Yes, I do had IBS, but it is a symptom of my Biliary problems. I did ask the Drs if it was IBS why does it only hurt right at my sturnum area? Why not all over? Couldn't give me an answer. I to had bloating and a bubbling feeling. I had a hard time eating salads. Seems to bring the pain on. Wish you luck in your search.

[jes]

I am 32.  I have been having upper abdominal pain since mid-January.  It seems to range under my ribs to my navel.  I have a reoccuring pain on the right side of the navel.  I also have visible spasms around the navel and sometimes in the right back side under the ribs.  I wake up in the middle of the night with cramps in the same abdonminal area often.  The cramps come and go throughout the day.  I have found absolutely no relation to food and I follow a low fat diet as I am a weight watchers life time member.  I have had an ultrasound to check for gallstones, blood work, stool samples, an upper GI because I am also dealing with acid reflux.  I have been diagnosed as having IBS but I am not "buying it".  I have been taking Zantac 300.  It doesn't help.  I have tried Dicyclomine for the spasms.  It didn't work.  I have also taken librax and it has offered no relief.  I feel as if I am having a baby when the cramping starts.  It can last anywhere from an hour to days.  My stomach gets so sore I feel as if I've been repeatedly punched.   I have nausea on a daily basis.  I have been told that IBS is aggravated by stress and I have never been under less stress than I am now!  The pain is relieved slightly after emptying a full bladder.  Standing seems to be the most comfortable position.  Any ideas?  Thanks

[tinaA]

Dear digitalman,  I can sympathise with your wife, I had the same problem, for 2 years i had terrible abdominal pains and every time i ended up at the hospital. The same as your wife stated, the only way i could describe it was like a vice and that someone was making it tighter and tighter. I know I have repeated myself before but do not ignore it, get something done and get a diagnosis. There are plenty of tests that can be done and as someone here has already said it could be a bile duct obstruction and to be really sure she will need an MRI. I am having an MRI on tuesday as I ended up with Pancreatitus (pancreatitis) 6 weeks ago and shocked my GP and Liver specialist as they said there was nothing wrong (no stones) with me other than Gilberts Syndrome. Had they done the MRI 2 years ago I would not have ended up in hospital for a week with the worse pain I have ever experienced ( I have given birth twice and that compared to this pain was a piece of cake)Good Luck and keep us posted

[Genevamom]

wow, your wife is experiencing the same thing that I am.  It is so frustrating.  Please keep us posted as I will too.

[tarndug]

I have extreme abdominal pain, but can't be sure that it's the same as described above.

I am a 23 year old female. One and a half years ago I ended up in the emergency room after an evening of extreme pain. I had gall stones (hereditary) and had emergency surgery that evening to remove my gall bladder. 4 or 5 days later I had my first attack of the pain. The pain is located directly under the zyphoid process, or point where the ribs meet at the bottom. It feels like a giant knot, or someone squeezing, and it is unbearable. There are times when I feel a mild burning sensation, but not always. I cannot function in any capacity until it is gone. I usually stand up, leaning over a table or desk until the pain has passed. During the first attack I got extremely hot, but that doesn't happen all the time. Sometimes I feel a little nauseous, but not always. Sometimes it is immediately followed by a bowel movement, but not always. I've found no link to diet or menstrual cycle. An attack lasts no more than 5-10 minutes. Attacks occur anytime of day or night (and at night they are so painful they wake me up and I am unable to fall asleep until they pass). The attacks can happen once every 3 months, once every week, and once I even had 2 in a row. Recently a dull version of the pain has become more constant. I have also found that since my gall bladder was removed, feeling hungry has become uncomfortable and slightly painful. There is only one way I've found that I can trigger an attack, drinking alcohol (not just one drink, but going out to a bar kind of drinking). That works most of the time, not all the time.

I have had bloodwork, x-rays of my abdomen, ultrasound, an endoscopy, an IVP, and a CAT-scan. Visiting a doctor or the emergency room is a waste, as the pain is so brief that it has passed before I can be seen. I've been put on Zantac, Prilosec, GI cocktails, etc., but the pain is so random and short in length that it is impossible to tell if anything has helped. The surgeon that removed my gall bladder thinks the next step is exploratory surgery, and I would be more than willing to do that if it would give me an answer. I will do whatever it takes to not have to live with this condition any longer. (Unfortunately I am currently without health insurance, so I have no choice but to deal with the pain for a few more months.)

I will continue to check back to find out if anyone has any definitive answers.

[Genevamom]

I'm curious about that bile duct problem you had.  Did your bloodwork come back good?  Do you know if pancreatitis always show up in the blood?  My symtoms resemble the pancreatitis and my doctor ran the blood for it after my last attack, but everything was fine. I've had the same pain for a year, before the gallbaldder came out.  My gallbladder wasn't working at all.  I still have the pain.

[Lor]

My blood work always came back normal for the first year after my gallbladder was removed. Then my liver ensymes starts coming back abnormal. Not by a lot just a little. My pancreas didn't show signs until after I had the ERCP with manometry.

I can tell you during the year and a half that I suffered with the biliary pain. There were times on and off that I would get the strangest stomach aches. Felt like I had food poisoning or something. It wasn't until I had pancreatitis that I figured out that I was having pancreatitis like attacks all along. My Dr told me months before that Chronic pancreatitis is very hard to diagnose ,because it can go on without changes in your blood work. Like me the signs came and went before I had a chance to see a Dr. Since my sphincterotomy I have had no biliary pain, and only minor gas pain in the area of the pancreas which I'm told will go away once everything is healed. I feel for me the risk involved with the ERCP with menometry was completely worth it. I have now been pain free for 3 weeks.

[Genevamom]

Thanks for your reply.  I'm so happy to hear someone is pain free.  If my doctor suggests the ercp, I am going to agree to it with hopes of a cure for all these attacks.  I just wish there was a for sure way to check the pancreas.  Is there?  A ct scan?  Thanks again.

[Lor]

Remember that it isn't just the ERCP. You have to have the ERCP with menometry. This is where they measure the pressure in the bile duct. If the pressure is high they do a sphincterotomy. It has to be done by a Dr who has done hundreds of these tests. My Dr refered me out to have it done because he didn't feel safe. The risk for pancreatitis from this is very high.
The only thing I know about the pancreas is if it is Chronic pancreatitis this will cure it in most cases. (this is what I was told) Look up borland-groover.com and research sphincter of oddi dysfunction. Good luck I hope this helps you. So many people on this forum are not willing to take  the risk of this test, and seem to stick with probotics or other natural rememedies. To me I'd rather get rid of the pain for good.

[MissM]

I am a 39 year old female. You described me to the max. I have had all the same tests and most of the drugs your wife is taking. I had my gallbladder removed in April 2002 but the constant pain in my upper stomach has just gotten worse. I had no symptoms that were related to gallbladder trouble, they found it was bad by accident. I recently developed nausea nearly every day, and to eat a hamburger, pizza, or fatty food, I would rather die. I had an MRI done on my pancreas and bile ducts this past week and they discovered that I have a stricture on my ducts that will require surgery. You can find out all the information on this by asking Jeeves information on BILE DUCT STRICTURE. I hope this helps you. I've been in agony for 6 months now and the doctors could care less. Hopefully the surgery will help. Good Luck to your wife and tell her to see another Gastroenterologist and have a an MRI on her bile ducts. The nuclear scan, upper GI, ultrasounds,etc. never showed anything on me either. Just to let you know, they only scan certain areas at a time on an MRI, not the entire abdominal area like I assumed, so ask for the bile ducts.