Dr. Muhammad Shoyab
Radiodiagnosis
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am 55-year-old. My weight is 135 kg, and my height is 183 cm. I would like an opinion on my pain in the abdomen, feeling of a hernia, or some tissue movement causing a biting, pulling, and ripping sensation. I stopped using a belt after 40 years and instead used suspenders. My stomach and muscles are not used to the lack of a belt. I had vigorous sex the night before. I woke up and felt like my abdomen was about to fall out, and I could only move a little while holding my stomach like I was pregnant. I also have edema and severe swelling of my legs and hips. Hematomas and blue marks are also forming under the skin. After six weeks, the pain worsens if I stand or sit for long. I have a heavy feeling in the lower abdomen, like folded flesh sensation. The glomerular filtration rate is 40 mL per minute, and now, it is 63 mL per minute flow. So kidney failure stage is 3B, and plasma creatinine is 163 mmol per L. The blood test also shows that the reticulocyte count has increased to 169 cells per µL. What would explain the extreme pain and sensation of the muscle being torn and the loss of power in muscles? I also have GERD because of overproducing stomach acid. I also have mesenteric paniculitis. The hernia belts relieved some pain. Currently, I am taking tablets Metoprolol 50 mg, Somac 40 mg, Aerius, Lamictal, and Candecor comp 16 mg/12.5 mg. Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern. Your CT (computed tomography) images (attachment removed to protect the patient’s identity) have not been properly uploaded. Without that, it is difficult to provide a radiological or clinical opinion with only the blood reports (attachment removed to protect the patient’s identity). Therefore, I would request you to upload the CT images again, and I will be ready to get back to you with the interpretation and advice.
Kindly revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply. I have attached my CT scan reports. Kindly help.
Hi,
Welcome back to icliniq.com.
I understand your concern. I have gone through all the image (attachment removed to protect the patient’s identity) sequences and reviewed your clinical description. Considering your age, weight, and everything, I think the present problems you described are correlated with distension of the abdomen due to obesity and consequent thinning or weakness of the abdominal wall muscles. It also explains why you have swelling of the hips and legs and why you feel like your abdomen is falling out in the morning after vigorous efforts the night before. However, you already know about having panniculitis, and there are also multiple cysts in both kidneys and all over the liver, which means you have fibropolycystic disease. Two cysts in the left kidney are greater than 6 cm, producing abdominal pain. Panniculitis can also produce abdominal pain. However, there is no hernia, and nothing is falling out. As far as the kidney cysts are concerned, I suggest you consult a urologist, and they may consider whether you require drainage of the larger ones. The panniculitis, I suppose, is transient, but you can still consult your general physician or internist if you feel your present medication is not adequate. So, overall, you need to address the kidney cysts, panniculitis, and body weight.
Kindly revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply. What about the 30 mm juxtapapillary duodenal diverticula? Kindly help.
Hi,
Welcome back to icliniq.com.
I did not see the juxtapapillary duodenal diverticula (JPD) and should apologize for any confusion it created at your end. JPD is sometimes (10 to 20 %) found on endoscopy or ERCP (endoscopic retrograde cholangiopancreatography). It is often implicated in hepatobiliary diseases. But I presume it may correlate with GERD (gastroesophageal reflux disease). Symptomatic JPD may require removal by endoscopy or surgery. So, if you have already contacted concerned specialists, I suggest you proceed accordingly.
Kindly revert in case of further queries.
Treatment plan
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Radiodiagnosis
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