Distended stomach due to gas?

[sunshine383]

Hi Dr. Goodman,

My mom had a recurrence of ovarian cancer in Jan07 and started a clinical trial and had her first treatment last Tues- Jan29.

About 3 months ago she started getting severe lower pack pain that was first attributed to subluxation,then it was a pinched nerve and in the end they said it was a twisted muscle. In the process she was given many drugs: pain killers, anti-inflammatory, muscle relaxants. She had a few sessions of deep tissue massage and the last one caused a fever and tremedeous pain. That’s when the swelling started. Her stomach became distended, she looks like she’s 7 months pregnant. She doesn’t eat much and her legs are swollen too. We ended up in the ER last Wed and did blood/urine tests, everything was normal. ER doc said it must be ascites and she needs to get a paracentesis done. So on Fri we were at the hospital to get it done but the ultrasound showed there’s little fluid and doing a paracentesis will be dangerous. We saw her oncologist and she said her stomach is full of gas because of the cancer irritating the bowels, and gave her a laxatives.
The following Mon she went to the hospital to do some tests for the treatment. Her weight was 150lbs. She did the treatment on Tues and it went well. Wed her stomach got bigger and we went to the ER again. Afte an xray the ER doc said (again) she was full of fluid.
Thur we called her nurse and she said the radiologist was an idiot and that it’s not fluid but gas and that she can’t do anything but continue the laxatives.

On Fri she was 160lbs! We don’t know who else to turn to, one doc tells us one thing and another doc says the opposite. My mom’s largest tumour is just smaller than 3cm, her last CT was 4 weeks ago. So how can the cancer cause such a great irritation to the stomach and make her stomach THAT distended? And is there eally nothing she can do about it except laxatives?

Sorry for the long note Dr. Goodman, thanks again for reading this.
Sandra

[Annekathryn Goodman, M.D.]

Hi There,
the fluid will keep coming back until chemotherapy dries it up. I am sorry to hear about what she is going through. it is so rough!
please keep us posted
best wishes

[sunshine383]

Hi Dr. Goodman,

For two days after the procedure my mom was feeling great. She could sleep and eat and her spirits were up. Then she started loosing her apetite and feeling sick whenever she ate. Her stomach is still distended and hard as a rock (although not as distended was it was before), is this normal? How long, after a paracentesis, does it take for the stomach to shrink, if at all? Her oncologist's response was "I told you so, I told it would come back".

We might have to schedule another procedure this week if an ultrasound shows fluid. Is it possible for ascites to accumulate so much fluid in a week?

Thanks again Dr. Goodman.

[Annekathryn Goodman, M.D.]

Dear Sandra,
thank you for the follow up. How is your mother doing now?
take care

[sunshine383]

Thanks for your prompt response Dr. Goodman.
We had to take my mom to the ER again yesterday. She was getting worse. She had pain when she ate and drank and even vomited a few times. The doctor did an xray to see if there’s an obstruction. There wasn’t one, so he sent her to do a CT scan. The clearly showed the fluid and her performed a paracentesis right then and there. He drained 4 liters of fluid! 4 liters! When just on Thursday her clinical trial nurse (and doctor) said the other doctors were idiots for saying she needs to get this done. They tested the fluid to see if it’s infected and it wasn’t so we took her home.

I know she’ll have to do this procedure again, but for now the pressure is relieved and she can focus on getting better.

Thanks again Dr. Goodman, I really appreciate it.

[Annekathryn Goodman, M.D.]

Hi Sandra,

Thank you for your detailed information.  The two types of xrays that are really helpful in seeing fluid or ascites are ultrasound and CT scan.  Sometimes physical exam can be misleading especially if the abdomen is distended.  So if either of those types of xrays did not show ascites, the cause of the distension is either tumor or bowel distension. If the CT scan does not show a larger sized tumor, then it must be her bowel.

if she is really uncomfortable or in pain, I worry about a bowel obstruction. the bowel can be blocked either in the small intestine or in the large intestine.  Sometimes a large intestinal obstruction is hard to diagnose on a regular xray but a CT scan should be able to see that. The other option is to get a gastrograffin enema (like a barium enema but with water soluble dye).  You should ask your mother's doctor about those possibilities.

Please let us know what happens
take care