acute pain with low grade fever

[Gail__0__0]

  Hi all:
  For the past 3 weeks my husband has had acute right sided lower quadrant burning pain with an associated "squeezing" type pain at right mid quad, about 4 ins. from his umbilicus. This pain is associated with fever between 99.3F-99.8F. Initially it did not affect his appetite, nor cause nausea. He has noticed an increase in diarrhea since Feb/98. When the pain started the diarrhea worsened to several movements a day, including episodes that woke him at night. No blood seen in stools. Then all BM's stopped times 5 days. First BM was pencil thin and was followed several hours later by watery diarrhea. These 2 types of BM's alternated for several days. After each BM the right sided pain increases to the point where he is "guarding". He finds it difficult to sit. Pain is somewhat relieved when he is supine. He now has nausea and loss of appetite. The constipation is gone, related to bowel prep for colonoscopy. Colonoscopy was normal, although biopsy reports are pending.  CT Scan (with contrast) was normal. White count, pancreatic and liver enzymes were normal. Sed rate was normal. He was given 2 days of Trovan 200mg po and has been started on Bentyl. Dr. says IBS. I don't think so. What do you think?
  Thanks
  Gail
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Dear Gail,
As I completed reading your letter I recognized that several of the more likely causes for the symptoms had been excluded.  It is still necessary, however, to rule out Crohn's disease of the small intestine and infections before reaching the conclusion that the symptoms are related to Irritable Bowel Syndrome.  Stool studies for Giardia antigen and ova and parasites is needed.  Additionally, your husband should have a dedicated small intestine barium study to exclude Crohn's disease.  While you await the scheduling of these tests, symptomatic therapy of increased fiber intake should begin.  This treatment may improve symptoms, independent of the underlying cause.
This information is presented for educational purposes only.  Always consilt your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords; abdominal pain, irritable bowel syndrome
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