Patient's Query
Hello doctor,
I am a 39-year-old female suffering from abdominal pain and intermittent diarrhea. Had a CT with contrast that revealed bowel wall thickening in the ascending and transverse colon- possible transmural thickening, which may just be artifactual, but it did show up and warrants a GI consult. Abdominal X-ray was negative for obstruction, but there were distended loops of the bowel where the pain was. The main issue at this time is continued pressure and fullness on the RUQ and LLQ. Feels like I need to have more bowel movements and have incompletely evacuated. No nausea or vomiting. All labs are normal, including ESR. Colonoscopy and upper GI scheduled in a few days. How likely is Crohn's diagnosis with these symptoms and workup?
Hi,
Welcome to icliniq.com.
You have a suspected thickening of the right colonic wall and features of subacute obstruction (attachment removed to protect patient identity). Crohn's can be a possibility, but the chances are less. The next step would definitely be a complete colonoscopy.
I hope this helps.
Thank you.
Patient's Query
Hi doctor,
Thank you very much for your reply.
Since my colonoscopy was not scheduled for four days, I went back to the ER with concerns of partial bowel obstruction. Had a CT with IV contrast. All negative, so I will wait to complete the colonoscopy. Here is my question: the first CT used both oral contrast and IV contrast. Is oral contrast preferable in your field of study to enhance bowel pathology? In other words, if CT is only done with IV contrast, could it maybe miss the visualization of thickening of the bowel wall?
Hi,
Welcome back to icliniq.com.
It depends on the CT protocol of the center. Thin-slice CT with IV contrast is usually taken. Oral contrast distends the bowel and helps in the better delineation of luminal pathologies. For colonic lesions, a rectal contrast is also added (given like an enema). At some centers, water is used as the negative contrast for bowel. As far as your case, we already have a suspicion of right colon thickening, which definitely needs a colonoscopy.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
That makes sense. With this being said, would it be safe to say I am okay to wait for a colonoscopy, considering I maintain hydration and do not have severe pain? Unfortunately, when the CT W IV contrast came back negative, I felt it did not substantiate my staying, considering labs were normal.
Hi,
Welcome back to icliniq.com.
No problem in waiting for four days. Consider a liquid diet till then to avoid any bowel obstruction or pain. It also helps in clearing the bowel to facilitate colonoscopic examination. There is a 50 % chance of a colonoscopy being normal, in which case you can be relaxed.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
That sounds reasonable. And, I feel good as long as I am on liquids only. Also, what other areas would you explore in the event that the colonoscopy is normal, i.e. celiac, IBS, etc?
Hi,
Welcome back to icliniq.com.
Yes, nonobstructive pathologies. A biopsy from the distal small bowel or colon will be done if needed. As per CT, the small intestine was normal. So let's wait till the colonoscopy is done. Do not get messed up thinking of possibilities. You may or may not have one.
Please feel free to reach out in case of further queries.
Thank you.
Patient's Query
Thank you doctor,
I have attached the files.
Hi,
Welcome back to icliniq.com.
It is nice to hear that your colonoscopy is normal. Had a look at your angiogram report (attachment removed to protect patient identity). Celiac and SMA (spinal muscular atrophy) are the blood vessels from our aorta (chief artery of the body) that supply the intestines. There are a few scenarios in which the arterial supply to the intestines through these vessels becomes insufficient. These are rare scenarios and can happen due to the narrowing of the origin of these vessels from the aorta. This results in recurrent abdominal pain, which usually occurs after having food (postprandial pain) when the demand for increased blood by the intestine is not met.
The mere presence of a narrowing does not mean we need to treat it. Our intestines gradually adapt by developing collateral blood vessels. Some amount of narrowing can be present in normal individuals, too. Only patients who have the typical features of arterial insufficiency, like postprandial pain, weight loss, etc., need to be treated. Regarding your case, the pain is not typical, and your symptoms cannot be explained completely by this.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
Such a mystery. He wants to do a PillCam study as well. Does that sound reasonable?
Hi,
Welcome back to icliniq.com.
PillCam is basically a capsule endoscopy. You swallow a capsule that passes through the intestines and takes serial images. Relevance in your case, between the stomach and the colon, there is a long segment of intestine (known as the small intestine). The role of PillCam is mainly to see this segment. This completes the evaluation of the intestines. There is nothing wrong with doing this if we really have a suspicion of small intestine pathology. As I told you earlier, these may or may not be positive.
I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
I am uncertain if my GI doctor has really paid attention to these results. It concerns me that my platelets have dropped from 259 to 181 in just 11 days and my hematocrit has dropped from 38 % to 35.8 %. What are your thoughts?
Hi,
Welcome back to icliniq.com.
Nothing so alarming. Hematocrit varies depending on the hydration. Dehydration increases hematocrit and vice versa. Platelets normally vary between 151 and 400. So needs serial follow-up.
I hope this information helps you.
Thank you.
Patient's Query
Thank you doctor,
That is my concern about serial draws dropping. Is this not indicative of something autoimmune occurring? 292 to 181 within a month.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
Will my abdominal pain after cholecystectomy throw me into SVT?
I have Crohn's disease with kidney problems, and I want to gain weight. Kindly suggest a diet plan.
Having abdominal pain and bloated feeling for five months. Could this be due to colon cancer?
Is it necessary to reschedule colonoscopy after taking Ayurvedic medicines?
Is it necessary to get colonoscopy for blood in stool?
I have Crohn's disease, and all my joints are swollen and painful. Please help.
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.