What is your suggestion for my stomach pain?

Hi,

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Before proceeding any further, a few things I would need to know. How long have your symptoms been present for?

1. Why did you have your uterus and ovaries removed? Was it for cancer or not?

2. The first thing I note is that (attachment removed to protect patient identity) within the remit of your CT scan, the findings are not alarming.

3. However, it is not an enhanced scan and as such certain structures may not be assessable to the degree that they ought to be.

4. The gold-standard scan would be a triple-phase contrast-enhanced CT (computed tomography) scan of the abdomen and pelvis. This will give far more detail of certain structures, including the bowel.

5. You may have a pelvic infection to account for your symptoms and free fluid; however, I would like to pick up a few other things.

6. Although you are not anemic, your mean cell volume (MCV) is at the lower limit borderline of having a microcytosis. This itself is not necessarily alarming, but in conjunction with your symptoms and free fluid may raise further questions.

7. Your urine test demonstrates a sterile pyuria with a trace of protein. This is the presence of pus cells or inflammatory cells in the absence of active infection.

8. However, I would want to see if your urine culture grows any microorganisms, which may need treating. It may be that the antibiotics that you have been on have eliminated any infection and that has resulted in the urine test results you have presented.

9. Have you had any bowel symptoms, even mild, such as intermittent loose stool of feeling a little constipated? Have you passed any blood or abnormal color stool or mucus? Have you lost any weight? If you have any of these symptoms, then I would suggest undergoing a full colonoscopy.

10. Have you had any urinary symptoms such as discomfort or cystitis or bleeding or urgency or frequency? If so, then a cystoscopy to look at the bladder would be needed.

11. Have you had any vaginal discharge or blood? If so, a referral to a gynecologist would be needed.

In summary, there are many things that can account for your CT findings and symptoms. However, I would suggest a few further tests may be needed depending on any other symptoms, however subtle. The first thing I would want is a contrast-enhanced CT scan. Your current plain scan has picked up an abnormality in the free fluid, but cannot account the reason. If the reason you had your uterus and ovaries removed was for cancer, then I would suggest you undergo this scan urgently with a referral to a gynecologist.