Abdominal and hip pain--nerve problem?

[beanchibbit]

Hello,
My 12 year old son has been having a tough time.  In mid-November, he developed severe lower right quadrant abdominal pain.  He was evaluated for appendicitis at the ER.  X-Ray, ultrasound, CT, blood and urine were negative.  He was admitted for observation and released the next night.  He still hurt, but it was a bit better.  Since then, we have been bouncing between the pediatrician's office and the ER.  The only finding was a lot of stool in his colon (not his rectum). He was assumed to be constipated, despite daily bowel movements.  After an enema and several days of Miralax, the pain continued and a total flush (colonoscopy prep) was ordered.  Definitely cleaned out, but the pain persisted. We saw a gastroenterologist recently, and he has ordered a colonoscopy and endoscopy to check for Crohn's (based on a single episode of rectal bleeding and mouth sores 3 years ago, and possible indication of irritation at the terminal ileum on the CT).  It could be that, or IBD, or "nerve irritation."
About two weeks ago, my son began having pain in his right hip.  It became so severe that he felt he couldn't walk without crutches.  He had a hard time flexing his hip, so that sitting was painful.  Over the course of several days, the pain improved.  He's able to walk, but still reports pain.  We saw ortho, x-ray was negative.  Again, blood work was negative.  We saw a rheumatologist, who thought it could be arthritis or "nerve irritation."

It strikes me that his abdominal pain and hip pain are mere inches away from each other.  My question is this:  Could a single nerve problem be responsible for both pain sites?  This seems such a better fit than Crohn's, as he has not had any diarrhea and his growth has been unaffected.  The only consistent symptom is pain.  He has a history of orchiopexy and hernia repair on the right side, four years ago.  He also has Joint Hypermobility Syndrome and horrible posture.
Thank you.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Pain of the gastrointestinal tract can be referred meaning that the pain can also be found in other locations. The distal large intestine is innervated by nerves arising from the lumbar (low back region). The hip is supplied by different nerves from the same region. It is possible that the hip is referred pain. However, it is difficult to tell without ability to examine and also see where exactly the pains are arising. It is also quite possible that the pains are unrelated.

I agree that you and your son continue working with the rheumatologist and pediatrician. If not already done, it may be worthwhile to have an evaluation by a gastroenterologist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Heiferly]

You might also want to consider asking your pediatrician about the possibility of a referral to a neurologist or even a neurologist who subspecializes in neurological (nerve) pain. I recently got such a referral myself, and am very hopeful that this specialist will be able to address my pain. It is easiest to find highly subspecialized doctors if you look within larger research/teaching hospitals.

Best,
Heiferly.