Lower Right Abdominal Pain - Ovary Lying on my Intestines?

Hello,

I have had some severe lower right abdominal pain for the last several months that has gotten worse and more severe over the last few weeks.  I ended up in the ER because of the pain - they thought it was my appendix but cat scan said it was fine.  What they did find was a "mixed density bilobed mass in my lower quadrant" where my pain is.  

I went to my doctor who sent me to a general surgeon and the surgeon reviewed the cat scan with the radiologist and he says that he thinks it is my ovary sitting on top of where my resection of my intestines was completed that is causing my pain and has told me won't do the laparascopy and that only my OB can do this.  So I am now going back to my OB.

This could make sense - I had a hysterectomy in 2008 where my ovaries were left in and then a resection rectopexy for internal rectal prolapse in 2010 where the surgeon said he did a "side to end" reconnection of my intestines.

Question - what if this is not the issue?  Should I also have a general surgeon on hand in case it is adhesions or scar tissue or other organs being affected?

Any help or advice would be greatly appreciated - I almost feel like I am getting the run around from the general surgeon (I would have thought that he could have done the laparoscopy and been able to remove my ovary if that were the issue?).

Thank you to any and all that respond!

[Tuckamore]

Hi Koda,

What an interesting result. I think your surgeon's impression is entirely feasible. As you know Adhesion's cannot be seen on a regular MRI. It requires a very special type of imaging that all facilities do not have as of yet. It's called a Cine MRI.

I would assume that your surgeon would have the appropriate back-up or assisting surgeons on hand. When I was going to have a oophorectomy my OB said she must have two other surgeons assisting, a Thoracic and a Gastro. It's totally appropriate for you to express your concern and request additional surgeons during the surgical procedure.

I assume you are having this performed at a large teaching hospital so these types of medical talent will be readily available if required. I've learned over the years, not only from personal experience but from being in the field that anything more then a simply appendectomy or tonsillectomy is best performed in the larger facilities.

Surgeon's usually stick to their expertise, for their sake as well as yours. OBs know more about the type of surgery that is being suggested for you then a General Surgeon. You want the best, with the most knowledge of the procedure. I don't think you are getting the run-around. However I know how frustrating the referral process can be. It's like, "Just do it all ready and stop this pain... or take care of the problem."

Please let us know what you discover and the outcomes. I'll be interested to read your updates.

You may also want to copy and paste this on to our Urogynecology Forum. They may have more specific or additional information for you. Here's the link:
http://www.medhelp.org/forums/Urogynecology/show/743

I wish you the best and will look forward to hearing from you again soon.

Take Care,
~Tuck

[Tuckamore]

Hi Koda,

What an interesting result. I think your surgeon's impression is entirely feasible. As you know Adhesion's cannot be seen on a regular MRI. It requires a very special type of imaging that all facilities do not have as of yet. It's called a Cine MRI.

I would assume that your surgeon would have the appropriate back-up or assisting surgeons on hand. When I was going to have a oophorectomy my OB said she must have two other surgeons assisting, a Thoracic and a Gastro. It's totally appropriate for you to express your concern and request additional surgeons during the surgical procedure.

I assume you are having this performed at a large teaching hospital so these types of medical talent will be readily available if required. I've learned over the years, not only from personal experience but from being in the field that anything more then a simply appendectomy or tonsillectomy is best performed in the larger facilities.

Surgeon's usually stick to their expertise, for their sake as well as yours. OBs know more about the type of surgery that is being suggested for you then a General Surgeon. You want the best, with the most knowledge of the procedure. I don't think you are getting the run-around. However I know how frustrating the referral process can be. It's like, "Just do it all ready and stop this pain... or take care of the problem."

Please let us know what you discover and the outcomes. I'll be interested to read your updates.

You may also want to copy and paste this on to our Urogynecology Forum. They may have more specific or additional information for you. Here's the link:
http://www.medhelp.org/forums/Urogynecology/show/743

I wish you the best and will look forward to hearing from you again soon.

Take Care,
~Tuck

[koda2011]

Yes, my OB who did my hysterectomy is affiliated with a large hospital (one of the best rated in my area).  Last time when he did my hysterectomy he found a lot of scar tissue so the "simple" procedure that was only to take 2 hours turned into 6 hours.  I believe he did call in another surgeon to assist.  It is frustrating because I don't know how much longer I can take the pain - pain meds are not helping it and today (it is raining) it is so much worse and shooting all over my abdomen and down my leg.

I REALLY appreciate your advice and comments and will keep you updated.  

[cornishrex13]

I ended  up going to a surgeon that was a general surgeon that had a specialty in scar tissue removal. There is a product that they can use on any incision .They spray it on the fresh cut and it keeps the newly cut tissue from adhering to any tissue around it. If you are a person that gets allot of scar tissue I would make sure my surgeon knows about it. I'm sure he knows of it but he might not want to deal with it but I would insist. You are the one that must live with the possible adhesion's....Good luck. Let us know how things turn out.........cornishrex.

[koda2011]

Hello,
I see my OB on Thursday so will let you all know how we decides to proceed.  Thank you for the information on the product to reduce adhesions!

Sophia

[Tuckamore]

Yes Koda, Cornishrex is correct. There is a spray along with a few similar new products that surgeon's can utilize to decrease the formation of adhesions.

We'll watch for our update. Best of Luck!

[Tuckamore]

Sorry.... I meant to write "your" update. Having some pain issues myself today.

I'm sure you know what I meant to say. :o)

[koda2011]

Thank you - yesterday and today are tough pain days...has been gloomy and storming rain.

I will let you all know how it goes with my OB on Thursday!

[koda2011]

Hello,
So I have an update.  I went to my OB today and he said that my ovaries are perfectly fine.  However, he does believe that there are other issues going on related to my resection rectopexy surgery I had last year.  He thinks that it could be possible my ovary is tied to my intestines due to adhesions (yes, he actually believes that adhesions are possible and that they can cause pain!!! yeah!), but feels that the issue since my pain began after my resection surgery is better handled by a specialist surgeon.  So, he has referred me to a critical care trauma surgeon who I have an appointment with on Tuesday and he said that he would also speak with her.  He feels that at this point we need to address my pain issue aggressively and do a laparoscopy surgery, and then fix any problems that are existing whether it be adhesions, or issues from my resection surgery.  He said that in reviewing the operative reports of my resection surgery that he couldn't believe the amount of sutures and how many areas and where he sutured my rectum and colon during this surgery.  Thus, the need to have a critical surgeon do the laparoscopy so that she can fix any potential issues from this when she sees this in the surgery.  He will also be on call in case my ovary is concerned and is determined it needs to be removed.

I feel so relieved to find someone who actually cares, took his own time to review the full surgical operative report and all the tests I had since the resection and is going to follow through with me on this.  I am sure that his belief in adhesions is because when he did my hysterectomy, he found such tremendous scar tissue, that he is a believer in this and that it can cause pain.

I will continue to post updates after my appointment with the surgeon on Tuesday.

[koda2011]

Hello all.  An update.  I had laparascopic exploratory surgery this past Monday and the surgeon ended up finding that my ovary was fine but DID find an issue with my appendix and my intestine.  My appendix was being elongated by scar tissue and my intestines were kinked up so she removed my appendix and cut out and reattached a section of my intestines.  Recovering now so don't know for sure if this will alleviate my pain but keeping my fingers crossed.  Thank you all for your advice and kind words!