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Undiagnosed Symptoms (Expert Forum)
Recurrent severe abdominal pain
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
Recurrent severe abdominal pain
by cmcn, May 06, 2008 02:32PM
In 2005 I had an exploratory laparotomy, TAH/BSO with excision of two very large (14 cm each) ovarian cystadenomas. About 20 years prior I had excision of a unilateral 5 cm serous cystadenoma. Other surgical history includes laparoscopic cholecystectomy.
I'm having a recurrent problem with intermittent left/mid upper abdominal pain. The cycle seems to be approximately 10-14 days in duration, and then disappears for lengths of time varying between a couple of weeks to several months. When it occurs, the pain quickly increases in severity over the course of a few days, reaching a peak and remaining severe for several days, then slowly decreases over several days, all the while of which it feels like there's a large fat snake turning about in my left abdomen. There is a large amount of GI noise. I do have two incisional hernias, a large one (about the size of the palm of my hand) in the right lower quadrant, and a smaller one on the right upper quadrant. These do not appear to be incarcerated.
Because of the peristaltic character of the pain, I'm suspicious of adhesions causing intermittent partial small bowel obstruction. My question is that if this is the case, how serious a problem is it and how concerned should I be about obtaining/achieving a surgical correction? Also, is there a nonsurgical treatment that I could be initiating at home, say at the onset of the pain? I have no health insurance and seeking treatment could easily turn out to be financially devastating. On the other hand, when the pain is at its worst, it is what I can only describe as "mortal pain" and leads to anxiety attacks (because of a definite feeling of impending death, especially when pain radiates into the chest). Since this cycle has continued many times over the past year, I do not anticipate it correcting itself. I'm just recovering from the latest siege and already dreading the next one.
I'm having a recurrent problem with intermittent left/mid upper abdominal pain. The cycle seems to be approximately 10-14 days in duration, and then disappears for lengths of time varying between a couple of weeks to several months. When it occurs, the pain quickly increases in severity over the course of a few days, reaching a peak and remaining severe for several days, then slowly decreases over several days, all the while of which it feels like there's a large fat snake turning about in my left abdomen. There is a large amount of GI noise. I do have two incisional hernias, a large one (about the size of the palm of my hand) in the right lower quadrant, and a smaller one on the right upper quadrant. These do not appear to be incarcerated.
Because of the peristaltic character of the pain, I'm suspicious of adhesions causing intermittent partial small bowel obstruction. My question is that if this is the case, how serious a problem is it and how concerned should I be about obtaining/achieving a surgical correction? Also, is there a nonsurgical treatment that I could be initiating at home, say at the onset of the pain? I have no health insurance and seeking treatment could easily turn out to be financially devastating. On the other hand, when the pain is at its worst, it is what I can only describe as "mortal pain" and leads to anxiety attacks (because of a definite feeling of impending death, especially when pain radiates into the chest). Since this cycle has continued many times over the past year, I do not anticipate it correcting itself. I'm just recovering from the latest siege and already dreading the next one.
Doctor's Answer
by Kevin Pho, MD, May 07, 2008 12:46PM
, May 07, 2008 12:46PM
Adhesions are certainly possible given the history of prior surgeries. A CT scan would be a reasonable test to exclude this possibility.
If this is the case, surgical correction would depend on the extent and severity of the adhesions.
There are some experimental medical therapies to prevent future occurrences of adhesions such as icodextrin or hyaluronic acid.
These options can be discussed with your personal physician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
If this is the case, surgical correction would depend on the extent and severity of the adhesions.
There are some experimental medical therapies to prevent future occurrences of adhesions such as icodextrin or hyaluronic acid.
These options can be discussed with your personal physician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
