Dr. Sameer Kumar
Obstetrics and Gynecology
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Patient's Query
Hi doctor,
I have had small cysts in the past that would come and go during childbearing or menstruating years. I also have IgA deficiency, chronic inflammatory arthritis, autoimmune hypothyroidism, and a low WBC count. My present condition is, for the past several weeks, I have been having pain in the lower left area of my abdomen that goes into my left lower back and on the side of my left hip or front at times. I also get pain in the lower pelvic area and sensations in my bladder like it is being kicked, like when I was pregnant. I have decreased appetite, abdominal bloating, and swelling on the left side of my abdomen. It is quite uncomfortable to have a bowel movement, and I have increased constipation.
Most of the time, I have very little appetite, and when I do eat, I get full very quickly. I also have nausea on and off, and at times it is so bad I feel as though I am going to vomit, but I have not. Three months back, I had a sigmoidectomy for chronic diverticulitis. After two months, that is last week, due to the above symptomology, I had a CT and flexible sigmoidoscopy done as my treating doctors felt there could be a narrowing of the colon formed during the healing process. Both tests were good; no problems or obvious issues (other than constipation) were seen. Now I am on Prozac, Synthroid, Hydroxychloroquine, Methotrexate, Folic acid, Prevacid and Flonase. However, the pain and other symptoms have continued and actually worsened since. I am now thinking it is a cyst on my left ovary. How concerned do I need to be? And how soon should I see a doctor? I have attached my reports for your reference. Kindly guide.
Hello,
Welcome to icliniq.com.
The symptoms and an abdominal lump in the left lower abdomen with constipation and bladder symptoms with bloating and decreased appetite do indicate a possibility of a large adrenal mass which could be a developing and growing ovarian cyst or mass, which should be ruled out with an urgent ultrasound pelvis scan. As the possibility of a colonic stricture obstruction has been ruled out three months back, a sudden increase in the size of the abdominal lump with pressure symptoms does indicate a possible fast-growing mass or cyst. This can be a late manifestation of post-sigmoidectomy stricture, which was not evident then, but the possibility of an ovarian mass or an ovarian tumor cannot be ruled out. I suggest an urgent ultrasound pelvis scan and hence, please seek an early appointment with your gynecologist. Please follow up to discuss the progress.
Patient's Query
Hello doctor,
The CT was done two weeks ago and was normal. There is no lump, and I am aware of it, just all the symptoms I listed. What do you mean by a late manifestation of post-sigmoidectomy stricture? Again, had the flexible sigmoidoscopy five days ago, and it was normal, and also everything healed well. Would not the CT have shown something if present? Or is ultrasound best for this?
Thank you.
Hi,
Welcome back to icliniq.com.
If the flexible sigmoidoscopy was done just five days ago, then there is no indication or possibility for the colon to be involved in post-operative stricture. Also, as of now you have mentioned that a CT scan was done two weeks back, and the symptoms have been persistent before that; in that case, an ovarian mass or cyst would have been easily diagnosed in the pelvis if present. The other possibility is likely to be post-operative localized adhesion formation which is common and more likely over the left side. It can cause a pull and tug over the surrounding structures like the ovary, bladder, and small intestine (the ileum part of the small intestine) which can cause some pressure, pain, and stretch symptoms.
Constipation is likely to present for one to two weeks, but it must be avoided with increased water intake. Bloating and gastritis are due to secondary postoperative gastroparesis, which causes decreased motility of the intestine through decreased peristalsis and shall subside in a few weeks. You should get an ultrasound pelvis scan done with the aim of looking for adhesion in the perioperative area. As there is no accompanied fever, there is no suspicion of either pelvic inflammatory disease or UTI, so the possibility for adhesions post-operatively is more likely. Please discuss the possibility with your surgeon and opt for an ultrasound pelvis scan.
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Obstetrics and Gynecology
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