help with xray

[gerontion]

Hi, thank you for taking the time to take a look at this. My partner has been suffering from lower right flank and pelvic pain for five years. Her right ilium is anteriorally rotated when sitting and her left ilium is posteriorally rotated when standing or walking and there is some functional scoliosis. We are not progressing well with her Dr. in finding a cause to her problem. We have had a recent xray done, by the endocrinology dept at a local hospital, but the followup appointment was for two months time, this has now been cancelled and extended a further six weeks. A gait analyst found that She was "vaulting" over the left hip when She walked and suggested some obstruction in the lower left quadrant of the pelvic bowl, interfering with the adductors and iliopsoas. She has severe bloating, can only eat small meals and in the beginning, a long period of faecal impaction/severe constipation. Very severe constant pain radiates from the lower right quadrant across the mid and lower belly and under the left ribcage.
I really would be most grateful if anyone might suggest a possible basis for this pain that we can investigate further with her Dr. She had an appendectomy at 19 (now 48) an investigation for endometriosis five years ago (negative) and a caesarean section four years ago. Pain started in the 4th week of pregnancy.
Many thanks for your time.

[gerontion]

Hello,
thank you so much for your reply, it is much appreciated. We have now had an abdominal ultrasound done to rule out fibroids or masses, and the liver, spleen, uterus, common bile duct and ovaries all check out fine. It was noticed there was "significant fecal loading" when we received the initial report back from the xray and good deal of gas appeared on the US. H was prescribed 4 sachets of kleanprep colon cleanser over two days to try to release the faeces to see if there was a partial blockage. H was unaware of any constipation or slow digestion and was passing normal stools every day. On day 3, She experienced a sudden elevation in pain. Exactly the same symptoms, but at least twice as bad. She had only passed watery liquid, which remained coloured. I took her to our local hospital and they xrayed her again and the fecal loading had not changed. She is now on movicol to try to soften things up.
Can I ask, has anyone ever had a case where solid stools have compressed the sacral or pelvic nerves. The initial compaction seems to be at the end of the small intestine. It is difficult to get a CT here, is there any other way to scan this?
Previous history: Graves Disease, T4 of 62 on diagnosis of hyperthyroidism, currently fatigue/muscle weakness.
Many thanks for your help.

[Dr Santos]

Hi,
What other symptoms are present? I understand your concern regarding her  flank and pelvic pain. While anatomical issues may be an issue, she may also benefit from a referral to a gynecologist  to rule out pelvic or other gynecological issues. Additional diagnostic tests may also be done. Take care and do keep us posted.