Right Lower Abdominal Swelling: Causes and Necessary Tests

Swelling in the lower right abdomen resembling intestinal distension?

I can feel a tubular structure in my lower right abdomen that sometimes is very noticeable and other times less so, but I can still feel it.
I went to the hospital and had a CT scan, and the doctor mentioned that there is a place that shouldn't be distended, which is distended.
They suggested that it might be due to a blood vessel compressing the duodenum.
However, I do not have a loss of appetite or vomiting.
I was then referred to a general surgeon, who reviewed my report and stated that the distended area is not the duodenum, but still arranged for me to undergo a gastrointestinal X-ray to see if the contrast agent passes through the duodenum.
My current issue is that my intestines in the lower right abdomen are distended, and I am unsure why the aforementioned tests are necessary.
This problem in my lower right abdomen has persisted for almost two months, and I now feel a very noticeable tightness and pressure, with some pain when I press down.
However, the cause remains undetermined, and it seems that the tests may not have been appropriate.
I would like to ask the doctor if my condition and the above tests are necessary.

xuan, 10~19 year old female. Ask Date: 2017/05/21

Dr. Chen Jiaming reply Surgery

First, we generally use the umbilical region to differentiate between the upper and lower abdomen.
You described feeling something like the intestines in the right lower abdomen.
As for the previous examinations arranged by the physician, they seem to be aimed at diagnosing Superior Mesenteric Artery (SMA) Syndrome, which typically causes bloating in the right upper abdomen (specifically the second part of the duodenum), and this does not align with your description.
Many people experience localized abdominal sensations that feel like intestinal structures when they have abdominal bloating or constipation (fecal impaction).
Generally speaking, if you occasionally feel something and sometimes do not, there is usually no need for concern.
If you are truly worried, there is no need to specifically seek out ways to investigate what it is, as this will not aid in alleviating your symptoms.
Instead, it would be more meaningful to focus on addressing the issues of intestinal bloating or constipation.

Reply Date: 2017/05/21

More Info

Understanding the causes of right lower abdominal swelling can be complex, as it may involve various anatomical structures and potential medical conditions. Based on your description, it seems you have been experiencing a notable swelling in the right lower abdomen, which you can palpate and has been present for nearly two months. The fact that you have undergone imaging studies, including a CT scan and X-rays, indicates that your healthcare providers are taking your symptoms seriously and are trying to rule out significant underlying issues.

Possible Causes of Right Lower Abdominal Swelling
1. Gastrointestinal Issues: The right lower quadrant (RLQ) of the abdomen contains parts of the small intestine, the cecum, and the appendix. Conditions such as appendicitis, bowel obstruction, or inflammatory bowel disease (like Crohn's disease) could lead to swelling and discomfort in this area. The swelling you feel could be due to gas accumulation or inflammation in these structures.

2. Vascular Compression: As mentioned in your CT report, there may be vascular compression affecting the duodenum (the first part of the small intestine). This could lead to symptoms such as swelling and discomfort, especially if blood vessels are compressing the intestinal tract.

3. Musculoskeletal Issues: Sometimes, swelling or discomfort in the abdomen can be related to musculoskeletal problems, such as muscle strain or hernias. A hernia in the inguinal region can present as a bulge and may cause discomfort when pressure is applied.

4. Gynecological Factors: In females, gynecological issues such as ovarian cysts, ectopic pregnancy, or pelvic inflammatory disease can also manifest as abdominal swelling and pain. Although you did not mention any gynecological symptoms, it is essential to consider this aspect, especially if you are of reproductive age.

Importance of Diagnostic Tests
The tests you have undergone, including the CT scan and the upcoming gastrointestinal X-ray, are crucial for several reasons:
- Identifying Obstructions: The X-ray with contrast will help visualize the passage of the contrast material through your gastrointestinal tract, which can indicate whether there is an obstruction or abnormality in the intestines.

- Assessing Inflammation: Imaging studies can reveal signs of inflammation or infection, which are critical in diagnosing conditions like appendicitis or diverticulitis.

- Ruling Out Serious Conditions: Given the duration and nature of your symptoms, it is essential to rule out serious conditions that may require surgical intervention.

Next Steps
1. Follow-Up with Your Doctor: It is crucial to maintain open communication with your healthcare provider. Discuss your ongoing symptoms and any concerns you have about the tests and their necessity.

2. Consider Additional Testing: If the X-ray does not provide conclusive results, your doctor may recommend further tests, such as an MRI or endoscopy, to get a clearer picture of what is happening in your abdomen.

3. Monitor Symptoms: Keep track of any changes in your symptoms, including pain intensity, changes in bowel habits, or any new symptoms that may arise. This information can be valuable for your healthcare provider in making a diagnosis.

4. Lifestyle Considerations: While awaiting further evaluation, consider dietary changes that may help alleviate gas and bloating, such as reducing high-fiber foods or carbonated beverages, and staying hydrated.

In conclusion, while the situation may feel frustrating, the diagnostic tests you are undergoing are essential in determining the underlying cause of your right lower abdominal swelling. It is important to follow your healthcare provider's recommendations and to advocate for your health by discussing any concerns or persistent symptoms.

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