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Q. What is your suggestion for my stomach pain?

Answered by
Dr.
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 04, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a 55 year old female. I am suffering from stomach pain. My ultrasound scan was reported as normal. The CT scan report is normal with an impression as minimal free fluid in the pelvis. Our physician told that I have some infection in the intestine and was advised to take antibiotic and pain killer. I got my uterus and ovaries removed 10 years ago. Actually, I have pain in the right side of the abdomen and around the navel. General surgeons feel that it might be a muscle spasm or some gynecological symptom. Please give your valuable suggestion.

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Hi,

Welcome to icliniq.com.

  • Before proceeding any further, a few things I would need to know. How long have your symptoms been present for?
  • Why did you have your uterus and ovaries removed? Was it for cancer or not?
  • 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.
  • However, it is not an enhanced scan and as such certain structures may not be assessable to the degree that they ought to be.
  • The gold-standard scan would be a triple-phase contrast-enhanced CT scan of the abdomen and pelvis. This will give far more detail of certain structures, including the bowel.
  • You may well have a pelvic infection to account for your symptoms and free fluid; however, I would like to pick up a few other things.
  • Although you are not anemic, your mean cell volume (MCV) is at the lower limit borderline of having a microcytosis. This in itself is not necessarily alarming, but in conjunction with your symptoms and free fluid may raise further questions.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

The Probable causes:

Inflammatory.

Investigations to be done:

Contrast-enhanced CT scan and urinary culture.

Differential diagnosis:

1. Inflammatory.
2. Infective.
3. Neoplastic.

Treatment plan:

I suggest an antimuscarinic agent such as Buscopan (Hyoscine butylbromide) or Mebeverine for symptomatic relief of pain along with your current painkillers. Consult your doctor, discuss with him or her and take the medicine with consent.

Regarding follow up:

Revert back with the answers to the above questions to a general surgeon online.---> https://www.icliniq.com/ask-a-doctor-online/general-surgeon


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