Undiagnosed right lower quadrant abdominal pain...

[chriscan]

Hi
I am a healthy (except for pain) 30 year old female who has been suffering from intermittent, chronic right lower quadrant abdominal pain for the last 15 months.   I've seen an internalist, ob-gyn, gastroenteroligist, and urologist.  These are the tests I have had:
1) several ct scans, two with a barium enema and one with contrast
2) cystoscopy (they thought I had a kidney stone stuck in my ureter)
3)Upper GI
4)colonoscopy
5) laparoscopic surgery by my ob-gyn (found peritoneal fluid around uterus, no signs of endometriosis)
6) ultrasound (found normal ovarian cysts and one 2 mm kidney stone in right kidney)
6) many blood tests, to the extent I'm not quite sure
Everything has come back negative.

My symptoms are very irregular...sometimes I think they are cyclical with my menstrual cycle and when I ovulate, sometimes it's after eating.  If I put my hand on my abdomen while I'm in pain, I feel a lot of intestinal movement.  I have a lot of lower back pain.  I also have pain in my buttocks that goes through my leg, and also below my right shoulder blade.  Bowel movements hurt and even sometimes when I urinate.  Sometimes I feel as if my uterus is prolapsing because I feel pressure.

My gallbladder looked normal in the laparsopic surgery...could my doctors be missing something?  What about my pancreas?  I assume all of those things would have been checked.  The only time I am not in pain, is at night when I'm asleep and a couple hours in the morning.  And it hurts more when I sit for a long time or if I don't exercise.  I'm on progesterone, just "in case" it's gynecologically related.  The pill seemed to be working for a few months, but now I'm back to everyday pain.  Is it possible to have missed endometriosis upon laprasopic surgery?  And, is there any other (non-invasive) diagnostic road I should take?  Neurologist?  Psychiatrist?  MRI?

I should also mentioned that I suffer from anxiety that I have been medicated for in the past, but not at the moment.  Is this all in "my head"?  I'm not a hypochondriac, because I've accepted the results (for the most part)...but I'm still in pain and I don't know what to do...it's affecting the quality of my life with my husband and 2 children...and I do still sometimes worry that something was missed...

Thank you for your help...

[nkotbfan4evr]

I have sharp stabbing pain in the lower right side. I have had so much rectal bleeding that it fills the toilet. I have also had blood clots & a low grade fever of around 99.8. My normal temp is 96.8. I have had my apendix out. My cecum became infected too, so they had to do a resection. I have also had a lap & a total hysterectomy due to Endomitriosis. I was in the ER last week & they did a CT scan. All looked ok. I have a colonoscopy on the 23rd od Dec, but the pain is so bad at times that I'm not sure I will last that long.
                               A.M

[Devin404]

A related discussion, Possible Suggestion was started.

[tiredofpqin]

I am a 38 year old female.  I have had severe lower right abdominal pain for 7 months.  I have had numerous test including a laparoscopy to rule out adhesions.  Nothing, had a complete hysterectomy 12 years ago for ovarian cysts.  I have had a CT that did show possible crohn's in the illieum.  Went to the GI and had a colonoscopy he pretty much agreed with the CT.  I am not the typical crohn's patient.  I do not have diarrhea matter of fact I'm the opposite.  I can go 7-10 days and have only 1 bowel movement.  I started on Pentasa and had severe diarrhea the doctor stopped that.  Can't be on prednisone because I am diabetic and it raises my blood sugar so we started Endacort.  After 4 weeks of that I felt like I was going crazy and the doctor took me off of that and we started with Remicade after the second treatment my body reacted to that so we stopped that.  Beginning in December we started Methotrexate I was on that for 14 weeks.  Made the pain tolerable along with a pain patch.  But, I developed abnormal liver function tests high ALT and AST levels so we stopped that.  About 8 wks ago I developed upper right abdominal pain.  I have had eight ERCP'S in the past with stents placed but after 10 days they had to take them out because my body reacted to them.

I have gone to a pain clinic which was suggested that I go to a physical therapist who deals with abdominal pain.  Have gone to PT for 10 sessions without alot of relief.  I have gone to a ob/gyn had pap smear that was normal, gone to urologist exam was normal.  I have had enough blood tests done to choke a horse and everything comes back normal except when I was on Methotrexate.

My GI doctor sent me to a Crohn's specialist who on the first visist agreed that it was Crohn's and we decided that I would stay on the Methotrexate until June but then the abnormal labs came back.  Was sent to a liver specialist who basically guanteed me that the abnormal labs were NOT from being on Methotrexate.  I was tested for various Hepatitis's which came back all normal.  Well, after having blood drawn 4 times in a week to look at how my liver function numbers were.  The liver specialist basically ate his words and realized that the abnormal liver test was because of the Methotrexate. (liver function tests are back to normal after stopping Methotrexate)Now the Crohn's specialist told me yesterday that he thinks that I may not have Crohn's because I don't have the so called "normal symptoms".

Is their anyone out there who has lower right abdominal pain with no diarrhea that has been diagnosed with Crohn's?

[SweetBon]

did they take any biopsies when they did your colonsocopy?

sweetbon

[Slcrsp]

Thank you all for being so honest!!  I am 36 and have had lower quadrant pelvic pain for about 3 years.  I thought I would try the tough girl routine since I do not have favorable history with the AMA, and try to muscle thru this.  I have now tied a knott at the end of my rope and feel like I am hanging on for dear LIFE... The pain has become so debilitating that I can't "Do my life anymore"
My ob-gyn has started the process and thus far I have done the Pelvic exam, pap, 2 ultra sounds and one vaginal ultra sound, and yesterday a CT scan.  The blood work and all the other diganostics have come back normal.  Now it seems the next step according to my Dr. is the Laporoscopy...  I have been so let down by having "normal results" and am starting to think that these Dr's must be chalking it up to me being a NUT CASE...  How do you explain to someone that you have been in your body your whole life and you know when something is NOT RIGHT????  Just like driving your faithful but old car...You notice right away when it starts making a new a different noise!!!!!  I would like to learn from your experiences and be able to ask the most effective questions when I see him on the 28th of Feb to schedule this next procedure. I do not have all the experience you ladies have since I am just newly starting this UNREAL process.....  EEEEEEEK!!!!!!!!
Thank you very much for your support and ideas.  It might end up saving my life....

SLC

[Mickey326]

I am an 18 year old female. I have been suffering from lower chronic right quadrant pain. It has been 12 months now. I am done:
1) 2 CT scans with that drinking contrast.
2) I have had an IVP test done
3) Numerous blood tests
4) Numerous STD/HIV tests
5) PAP smears and pelvic exams
6) Countless chest X-rays
7) Barium Enema (same as colonoscopy im guessing)
8) CCK HIDA scan
9) Gallbladder surgery (removed it)
10) Pelvic Ultrasound
11) On the stomach ultrasound
12) Laparoscopy
13) Upper GI Endoscopy


The list goes on. Hurricane Katrina came and made me evacuate to Texas, well, I came back home to new orleans the day that the storm hit and had a huge anxiety attack and went back to Texas where I stayed for about 3 months. Anyway, the pain seemed worse like it might just be all in my head from anxiety. So, I went to a doctor in Texas and he sent me for that CCK HIDA scan and found out my gallbladder was only working 11%...so i said ok...they took it out and i waited to see if the pain would be gone...well it wasnt. And honestly, i dont understand why I have a huge feeling buldge of something popping out of my right side. Its like a part of my intestines lifts up or something. Please explain that if you can.

Well, insurance is denying every test i do since the surgery (go figure) and im guessing it isnt mental but recently, like 4 days ago i did that endoscopy and he said quote" granularity and erythema in the stomach body compatible with gastritis (biopsy)" im waiting for the biopsy to come back on feb 27th.

so i dont know if my pain and the mass rising in my right side could be gastritis...but then again, i did that laparascopy with the gallbladder surgery and he said every organ was normal (appendix ovaries small and large bowel liver etc.) but i had adhesions(build up?) on the right of my stomach wall and he "lysed"-(I guess desinigrated) them.

So im wondering if that matches somehow with the granularity blah blah...the pain goes from my right leg all the way down to my foot and sometimes up to my shoulder...I eave have to sleep on my left side with my right leg behind (kind of under)my left foot.(because of that rising mass I feel in my hip) sometimes i cant sneeze or cough and lately i cant urinate. I urinate regular but it still feels like wen you held it in for a looong time and then let it out.I cant try to push anything out at all, like i have to sit down for a second to let everything move back into place or something. so i dont know what that is about. But with the information I provided I wish one of you can help me because this is to much for me to be going through being 18 and doing all these tests within one year. Please email me too if you might have any kind of explanation. ***@****

Thank you all, and God Bless. Mickey326

[chriscan]

dcdre-
You know, I wondered about chronic appendicitis...and I have never asked my obgyn if she looked at my appendix during laproscopy.  I should have just had it taken out at the time.  But, nobody suggested that to me.  Now that I think about it, when I had an xray series of my small bowels, they said it looked like I had a partial filling defect in my appendix, but it was nothing that would cause pain.  I don't want another surgery, but I would if it made my pain go away.
Thanks

[NickyIsHere123]

Think the days of mad scientists are gone?

Just take note of a paper written on CT scans:

http://www.mindfully.org/Nucs/2004/Full-Body-CT-Scans31aug04.htm

[chriscan]

Thank you for your comments, I appreciate the quick response.  I see my ob-gyn today, and will bring up the idea of these further tests.  And, I quite agree, no more cat scans for me...I have had enough radiation this last year to last 2 lifetimes...but it's always a doctors first diagnostic test to use...

[dcdre14]

Hi,

Have you had your appendix evaluated... or maybe already removed?

I suffered from vague lower right quadrant pain on and off for two years... I visited my regular doctor about it many times.. Sometimes it would get so bad I'd go to the ER, where they'd perform the requisite series of tests (blood work, physical exam, the occasional CT scan) before telling me I had any number of minor ailments (gastritis, colitis, IBS, IBD, constipation, anxiety issues, an ulcer... even a pulled abdominal muscle)!!!

During one particularly acute episode, I went to a more reputable ER, where they suspected I had "chronic appendicitis" - a rare condition in which the appendix flares up mildly every once in a while (as opposed to what it normally does when it's inflamed - ruptures!!!).

They took my appendix out two days later, and I have been pain-free since...

I guess some doctors debate whether chronic appendicitis is possible... Some think it's either all or nothing when it comes to appendicitis... Well I believe in it after the two years of pain and co-pays I put in!!!

[NickyIsHere123]

Hi, you sound a lot like myself. I actually had what is called a HIDE scan test done to measure the gallbladder's function. Usually they give a percentage back on the results. Anything below 35% is considered "abnormal", but this whole idea of gallbladder malfunction is not fully understood. They do not know for sure what causes it. I WISH THEY WOULD!!! Perhaps so many gallbladders be not needlessly removed. At any rate, I would try having this done. Another route would be nerve damage or neuropathy of some kind. How you got it, it could be from a prior surgery or could be from infection maybe. You did mention the fluid build up. I am wondering if that is not the cause of pain. In any regard, you have to make a choice to help your body heal , and I would suggest starting with your diet. You body can heal itself, it has to have certain properties though. You may want to consider researching juicing and the power in food. I did this, and have turned my condition around. I have also read where several medical doctors have witnessed the same thing ( i.e. Dr. SAndra Cabot). Finally, think very carefully about having more CT scans performed. This test sends the same amount of radition into your body that was found in dome survivors of the Hiroshima bombings. They do not tell you this when you have the test, but they are not sure what the aftermath of the test will bring (i.e. tumors) Just THINK...some of these doctors send patients to more that one CT scan a year, and I believe this is wrong. You need to take a look at both sides of the coin at all times.

Good Luck and hope this helps!

[Kevin Pho, MD]

You have been throught a comprehensive evaluation.  If there was a major abdominal disease present, it would have shown up in some for on the tests that you have had.  

The pancreas typically presents with left upper quadrant pain.  

You can consider more specialized testing at this time.  The right lower quadrant is in the area of the terminal small bowel - and sometimes can be difficult to image, despite the upper GI series or colonoscopy.  

You can consider a small bowel series, as well as capsule endoscopy, to further evaluate the small bowel for an inflammation or possible Crohn's disease.

If the testing remains negative, you can consider irritable bowel syndrome.  Treatment can be considered with anti-spasmodic agents.  If there is constipation present, Zelnorm can be tried.

This option can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b