Question: I have been experiencing severe pain and abdominal swelling on and off for six months. I look 4 months pregnant when this happens and usually in a couple of days my stomach is flat again. In February a CT showed a subcentimeter cyst of my liver, free fluid in culde sac and right adnexa. Kidneys, bladder, pancreas, spleen are normal. Gyn believes a cyst ruptured however pain and swelling haven't gone away this time. A repeat ultrasound March 4th shows enlarged liver sagittal right lobe 17 cm with minimally increased echogenicity no focal lessions. Normal Gallbladder bile ducts, common duct caliber 3mm, color wall thickness 2 mm. I am a 5'4" woman 150 lbs. Can you please confirm diagnosis and recommendations? What should I do to help swelling go down?

Previously, I would feel cramping, sometimes on left and/or right side, then few hours later or the next morning I would wake up with my stomach swollen. Normally after an attack, the swelling would go away the next day or two and I would wake up feeling/looking normal without having a lot of gas, etc. Now after the attacks, it is progressing to 3 or 4 days, but this last attack was different.

The ovarian cyst ruptured on 2/21/16, I couldn't walk and pain was on right side and in my back and going down my right leg. Stomach swelling occurred at the same time. A week later I had a similar episode where I couldn't walk and sever pain, etc. Swelling has not gone down for 13 days.

I had a miscarriage in January 2015. Over the past four months, my breasts have been sore and full and I have taken several pregnancy tests that were all negative.

2/26/2016 ultrasound confirmed free fluid seen on 2/21 was now gone/absorbed, no adnexal masses, nabothian cysts present in the cervix, complex cyst present in the right ovary measuring 1.6x1.4x1.3 cm. the right ovary measures 4.5x2.6x1.5 cm. The left ovary 2.6x2.0x1.1

I do not have urinary complaints. Past four months experienced constipation and hard stools on and off. Occasionally I would not go to the bathroom for a couple of days and then an attack would occur, then the abdominal swelling follows. GI doctor prescribed Linzess that seemed to be helping in January and February but the attacks happened anyway.

During prior attacks, ER and Urgent care ran blood tests and xrays that showed excess gas and stool backed up in my colon and small intestine. 10/2015 blood test showed high and low levels MCHC 32.8 L, EOSINOPHIL 8.1 H, EOSINOPHIL # 0.7 H, SGOT/AST 25 H, BILIRUBIN 0.2 L, CO2 30.7 H, LIPASE 62 H. 2/2016 blood test showed similar results, MCHC 32.7, EOSINOPHIL 5.5 H, EOSINOPHIL # 0.5 H, AND SGOT/AST 27. All of the other levels were within range.

10/2015 CAT SCAN showed diverticulosis of the colon without diverticulitis and mild basilar atelectasis. Stomach swelling was present along with severe pain in ER. Prior endoscopy or colonoscopy discovered one small pocket-diverticulosis and I was aware of that during the summer time.

About two years ago, every blue moon I would bend over to tie my shoes or pick something up after routine exercise and i would experience XXXXXXX horse cramping in middle of my upper abdomen and under rib cage on right side. I didn't think anything of it and associated it with exercise and cramps until the attacks over the past six months that progressed to swelling and severe pain. The attacks happen almost every month and occasionally twice a month.

I appreciate your time and any feedback that you can provide. Thank you

I assume the swelling is pressing up against my intestines and stomach. In the interim what diet do you recommend? More liquid based? I have been eating small meals (turkey and salmon) and smoothies instead of a lot of meat during each meal.

Do you think the liver swelling is not of concern? what is the normal size for women since the sagittal right lobe of my liver is 17 cm?

What can I do to help reduce the swelling of my liver? This is day 14 and my stomach is still swollen.

Do you have a recommendation of a GI doctor in the DC Metropolitan Area that I should consider for a second opinion?

I double checked all of the blood tests and the tests you mentioned to check for cancer weren't done yet. I will definitely request the tests asap. Thank you for all of your help and professional insight. I look forward to hearing from you.


Can you also confirm whether I should exercise at all right now? Right now my back aches but otherwise the swelling and discomfort after I eat is the only problem.

Hello I went to the Urgent Care and they did a standing up xray that showed gas and a large amount of stool backed up in my colon and intestines. Thankfully there were no signs of obstruction.

They also ran liver function test and the results came back normal.

They also ran the CA 125 blood test and my results were 38.6 which were elevated from their normal range of 0-34.

The recent ultrasound on 3/4/2016 shows no free fluid in the abdomen; however, my stomach is still swollen and there is no change.

I have follow up appointments scheduled with my Gynecologist and GI doctors this week.

Based on the results, complex cyst present in the right ovary measuring 1.6x1.4x1.3 cm. the right ovary swollen measures 4.5x2.6x1.5 cm, enlarged liver 17 cm and the CA 125 test results, what is your diagnosis and recommendation?