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Had Chronic RLQ Pain And Undergone Three Surgeries. Incarcerated Hernia Removed. Thickened Colon Shown In Ultrasound. Take Colonoscopy?
Question: For the past 2 years I have had chronic RLQ pain, have had 3 surgeries trying to remove it. I have had an incarcerated hernia removed, and two sets of adhesion surgeries, all with the hope of improving it. Finally I was diagnosed with nerve entrapment syndrome and have been treated with botox injections. The adhesion surgeries and botox seemed to help for a while. Now six months later, and the pain is coming back, not only that, but I have developed LUQ sharp pains (which with the nausea landed me in an overnight at the hospital last week). An ultrasound of the abdomen has shown a very thickened colon in that RLQ site (rectum? Caecum?) and a fatty liver. What should I have done next, and as the pain is ongoing with waves of nausea and gets intense sometimes, should I be looking for more urgent attention? I had a colonoscopy done a year ago for this, but despite thickening being seen on the CT scan and blood in stools/mucous, my gastro did not see any abnormalities and took no samples - he was a bit annoyed as he had to add me to his list and he didn't see that I was emergent. Should I ask for another colonoscopy? I now live in a different city.
Sorry, I should make this a bit clearer.
I am asking about the RLQ pain really but wonder if the LUQ pain now being experienced could be referred pain from this chronic condition or a new condition? Just wondering if it's possible that the two could be linked in some way.....
Sorry, I should make this a bit clearer.
I am asking about the RLQ pain really but wonder if the LUQ pain now being experienced could be referred pain from this chronic condition or a new condition? Just wondering if it's possible that the two could be linked in some way.....
Brief Answer:
Possibility of TB Colon/Crohn's disease
Detailed Answer:
Dear XXXX
Thank you for providing a detailed medical history.
Both the pain may or may not be related. Upon carefully analyzing the history you have provided, in my opinion, I feel the following two possibilities need to be excluded:
1. Tuberculosis of Colon/Illeo-caecal region
2. Crohn's Disease
For obvious symptoms of on and off abdominal pain associated with nausea which may be due to sub-acute intestinal obstruction. Also stools mixed with blood and mucous with no obvious gross pathology on colonoscopy/CT scan, points towards possibility of Hyperplastic Tuberculosis of Illeo-caecal/Colon. This LUQ pain is most likely to be due to same etiology. Thickening of bowel will be seen in Crohn's disease too.
In view of these new possibilities, I would choose to evaluate you further. The diagnosis is confirmed by
1. Barium Meal and follow through examination & Barium Enema.
2. Collaborated by raised ESR and Lymphocytosis(May not be seen in all cases) and Purified Protein derivative (PPD) or tuberculin test.
3. Biopsy of thickened segment of colon
You should visit surgeon and discuss about the two possibilities and the tests. You can get this done whenever feasible.
Also do let me know if you have any significant weight loss? Weight loss is commonly seen in both of the above conditions.
I hope it helped. Wish you a Healthy life ahead.
Take Care
Regards
Dr Deepak K K
MBBS,MS,MCH
Possibility of TB Colon/Crohn's disease
Detailed Answer:
Dear XXXX
Thank you for providing a detailed medical history.
Both the pain may or may not be related. Upon carefully analyzing the history you have provided, in my opinion, I feel the following two possibilities need to be excluded:
1. Tuberculosis of Colon/Illeo-caecal region
2. Crohn's Disease
For obvious symptoms of on and off abdominal pain associated with nausea which may be due to sub-acute intestinal obstruction. Also stools mixed with blood and mucous with no obvious gross pathology on colonoscopy/CT scan, points towards possibility of Hyperplastic Tuberculosis of Illeo-caecal/Colon. This LUQ pain is most likely to be due to same etiology. Thickening of bowel will be seen in Crohn's disease too.
In view of these new possibilities, I would choose to evaluate you further. The diagnosis is confirmed by
1. Barium Meal and follow through examination & Barium Enema.
2. Collaborated by raised ESR and Lymphocytosis(May not be seen in all cases) and Purified Protein derivative (PPD) or tuberculin test.
3. Biopsy of thickened segment of colon
You should visit surgeon and discuss about the two possibilities and the tests. You can get this done whenever feasible.
Also do let me know if you have any significant weight loss? Weight loss is commonly seen in both of the above conditions.
I hope it helped. Wish you a Healthy life ahead.
Take Care
Regards
Dr Deepak K K
MBBS,MS,MCH
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your reply. An interesting suggestion! I will follow up with my doctor for a referral for more tests. No, I haven't been losing weight. Possibly I might have done if I hadn't stopped smoking, which tended to make me eat more, so I have stayed the same weight.
The mucous continues but haven't had any visible blood for a while.
Have not heard of that condition, sounds like something that third world countries might see more of....?
Thanks again for the prompt reply.
The mucous continues but haven't had any visible blood for a while.
Have not heard of that condition, sounds like something that third world countries might see more of....?
Thanks again for the prompt reply.
Brief Answer:
Wishing you a healthy life
Detailed Answer:
Namaste
Greetings of the day
Take care.
Wishing you a healthy life
Wishing you a healthy life
Detailed Answer:
Namaste
Greetings of the day
Take care.
Wishing you a healthy life
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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