fluid in pelvic area (CT results)

[mariemomof4]

First I have to aplogize and say that I haven't read through all the posts so I'm not sure if maybe my question was answered, but I'm feeling really anxious right now and am looking for a "quick" answer. This question is regarding my daughter, she is 16 years old, very tiny (95lbs) 5'2".  She is not sexually active.  Her periods are fairly normal,  they come pretty regularly but they do last sometimes 10 days or more and she classifies them as a heavy flow.  The past 2 months she has been complaining of severe abdominal pain, not only with her periods but "24/7".  She has a very high tolerance for pain and is very fit and active.  She is a runner and runs on the average 3-6 miles a day.  After I finally got her an appt with the gynecologist (I suspected a cyst on her ovary)  they did not do a pap test because she is not sexually active but the nurse practitioner did an internal, said she felt nothing and ordered a urinalysis and an ultrasound.  Both came back normal.  My daughter continued to complain of pain (she states getting worse) and of frequent urination.  I took her to our family doctor, explained the gyn appt and negative results and he order CT of abdomen and pelvis.  He just called and said there is fluid in her pelvic area and wants her to see a gastrointestinal specialist.  I'm concerned, confused, frustrated.  My daughter has not had her period this month, was due on 10th, is complaining pain is getting worse, and says she has to urinate constantly.  Why would she have to see a GI?  Shouldn't she be seeing a gyn?  Any answers or insight would be greatly appreciated.

[Annekathryn Goodman, M.D.]

Dear Marie,
You have done all the right things for your daughter. Abdominal pain can be due to infection, cysts on the ovaries, irritable bowel disorder, anxiety, and several other possibilities.

The NP did a good first pass evaluation with an exam, urine test, and ultrasound. You are right, a transvaginal ultrasound gives more detailed information about the lining of the uterus and characteristics of the ovaries. However, an abdominal ultrasound is the standard exam in teenagers and does give good information (no tumors present).

Fluid in the pelvis on Ct scan can be seen after ovulation.  A GI evaluation is reasonable to check for IBS.

It must be so hard to watch your daughter have such distress. It sounds like she is not being ignored and a careful evaluation is in process.
best wishes

[VictimOfMRSA]

Might she have a cyst on her ovary (a benign, functional cyst.)  I would also ask about PCOS (polycystic ovarian disease) if she does or possible endometriosis.  She's young and healthy, chances are it's something that will not require a laparoscopy (too many times they are done for cysts that would subside on their own IMO.)  Yes, I think she should be seeing an ob/gyn or gyn (BOARD CERTIFIED) and someone that specializes in teenagers perhaps? If not, look for good credentials or a referral. Perhaps the GI doc and the gyn can work together on this.

Good luck and keep us posted. I'm sorry to see no one answered your question yet, This is only my 2nd post on this board, I joined this evening.

Best of health to you and your daughter!

[mariemomof4]

Thank you for your reply.  Originally I thought it was a cyst on her ovary and that is why I took her to the gyn.  The nurse practictioner said she didn't feel  anything "unusual" when she did the internal exam and ordered an ultrasound (I'm assuming of only her ovaries). The ultrasound and urinalysis both came back negative but the ultrasound was only done transabdominal and not internal due to my daughter's size and the fact that she is not sexually active.  I am waiting for the gyn office to open so I can call them and ask what they suggest I should do because I really feel this is "female related" and really don't understand what a GI doctor would do unless my family doctor feels it is something totally different.

[mariemomof4]

Let me update you since my last post.  My daughter has continued to complain of pain, the pain getting so bad that she almost passes out, has hot flashes doesn't want to move, be touched etc.  The GI doctor ordered a colonoscopy and that was done and doctor said she was having "spasms in her colon"  OFCOURSE SHE WAS, she had to drink a half gallon of **** to make her ****!! Said she had IBS (mind you she goes to the bathroom on her own, every day, normal) So I think the GI dr is full of ****!  So I called the gynecologist office, updated them on everything my daughter has been through and insisted on seeing a dr.  We went to the dr yesterday and low and behold my daughter has "multiple follicles on the right and left ovary as well as a mass and visbly large cysts on both ovaries"  Imagine my surprise to find that this was stated on her very first ultrasound report that the NP told me was normal.  Now I am furious!!  My daughter has gone to several doctors, had a CT scan, bloodwork and a colonoscopy for nothing because it said right on the US report (from the very first dr that I had taken her to) exactly what is wrong.  So now my daughter is on a high dose of estrogen, narcotic pain pills and in a few weeks may have to have surgery.  How crazy is it that the doctor told me that there was nothing wrong when the results are right there on the report???

[rootietootie]

Jeez, I am sorry you have been through so much.  I know you must feel horrible and frustrated, I know I would.  Especially when it is your daughter.  Sometimes that feels like it is more then we can take when it comes to our children.  Try to change doctors and get in with someone whom you feel more comfortable with. My question is did the results of the original US report show the mass on the ovary?  I would take the US report and records and go to another doctor.   Good luck!  Shannon

[mariemomof4]

My daughter has been on the estrogen birth control and the pain pills for a week now and nothing is changing.  She had been on a low dose birth control (at my request) from the first NP for about 5 days then when we went to see the dr he put her on the estrogen bc and she's been on that for a week now.  Nothing is changing, other than her starting her period yesterday (dk brown blood) and she had previously been on her period 2 weeks ago prior to starting the bc.  She is still complaining of pain, she said the pain pill kind of numbs her so that she can tolerate it but it is definelty still there and she gets really bad pain about an hour or 2 before she can take another one.  She hasn't been eating or drinking very much because she says it makes the pain worse. She is getting sick to her stomach (no vomitting) and dizzy.  She had all these symptoms before starting any of the medicines so I know its not related to the meds.  Anyway my question would be, would it be unreasonable of me to ask the doctor to surgically remove the cysts now instead of waiting?  My daughter is absolutely miserable.  She used to be a very active and energetic teenager who was very involved in sports and went to state for running for the past 2 years.  She now wants to do nothing.  She quit her indoor track team (she had a very good chance of making it to state with that) and wants to do nothing but lay around the house.  She has a very high tolerance for pain so I know this must be very painful.  Please any insight would be greatly appreciated.

[Annekathryn Goodman, M.D.]

Hi there,

It is hard to comment without seeing the xrays.  You should definitely ask her doctor about all the possible options.   I am uncertain what to recommend without more information. Do you have the actual reports from her CT scan that you can put in this forum?
thank you

[Sunes]

First of all I am so sorry to hear about your doughter. My heart goes out to you both.
My question would be : why the RN was examining your doughter? it reminds me when I went to have my physical and the doctor brought a nurse that he wanted her to learn gyno stuff and she did not feel anything in Nov 2004 and in 2005 I was diagnosed with cancer! RN's  should not be allowed to do this!
Hope everything will clear for your doughter. I pray.Sunes

[PF_PVD]

I was diagnosed with a uninary tract infection at an urgent care center and sent home with antibiotics.  FIVE DAYS LATER I was diagnosed with stage iv ovarian cancer by an internist who suspected ovca immediately based on my symptoms.  Find another doctor and ALWAYS get a copy of any tests--it's your right.

[mariemomof4]

Thank you to everyone for their comments and support.  My daughter had a repeat ultrasound yesterday and we go to the gynecologist tomorrow to go over the results.  She is now on a stronger pain med and is still pretty miserable.  When we saw the dr yesterday he was really leaning towards surgery and mentioned the possibility of endometriosis.  My daughter has lost 8 lbs (she is 16 and weighed less than 100lbs already) she does nothing but lay in bed or on the couch.  This is not the active, energetic daughter I know.  I am very happy with this new doctor, he seems to take the time that my daughter and I need for him to answer every question and he is genuinely sincere with my daughters fears and reassures us that we will "make her better together".  I'll update you after the appt.

[VictimOfMRSA]

A related discussion, to Marie Mom of 4 re: your daughter was started.