Right Lower Abdominal Pain: Causes and Diagnostic Approaches

Q: Right Lower Abdominal Pain: Causes and Diagnostic Approaches

Hello： To diagnose Crohn's disease, an endoscopy with biopsy is necessary to confirm the diagnosis. <br>Whether it is Crohn's disease also requires the clinical judgment of a physician, who will arrange for further examinations. <br>It cannot be diagnosed solely by CT or MRI. <br

Right-sided abdominal pain inquiry?

Hello Dr.
Tsai, I would like to ask you a more detailed question.
I appreciate your response.
Last year, I experienced discomfort about 3 to 4 times in the same area (right lower abdomen to the pelvic region, with soreness, bloating, and a feeling of foreign body).
The examination results from August 2021 are as follows (recently, in January 2022, I started to feel discomfort again in the right lower abdomen).
The CT report states: 1.
Mildly stranding mesentery surrounded by minimally distended small bowel, suggestive of nonspecific mesenteric inflammation.
No ascites.
2.
No CT evidence of appendicitis or A-colon diverticula.
3.
Fecal retention in the colon.
OTHER FINDINGS: No overt lung nodule.
No pleural effusion.
No discernible nodule in the liver, gallbladder, spleen, pancreas, bilateral adrenal glands, or kidneys.
The abdominal aorta and IVC are normal.
Small nodes in the paraaortic and pelvic regions.
Inadequate distension of the urinary bladder.
No obvious bony destruction in scanned areas.
IMPRESSION: Nonspecific inflammatory change over the mesentery.
Fecal occult blood: Negative.
Blood test: CRP 0.43.
Ultrasound examination: indicated severe bloating, and I am very concerned it might be Crohn's disease...
(I have skin allergies, and I am unsure if it is erythema nodosum; when I visit dermatology, they only mention allergic reactions).
I would like to ask you: 1.
Is it true that early-stage Crohn's disease cannot be detected? 2.
Is it necessary to perform colonoscopy or enteroscopy to confirm the presence of inflammation? 3.
Are CT and MRI sufficient for diagnosis? 4.
Could it be caused by other diseases? Thank you for your patience in reading this!

Leo, 20~29 year old female. Ask Date: 2022/01/19

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: To diagnose Crohn's disease, an endoscopy with biopsy is necessary to confirm the diagnosis.
Whether it is Crohn's disease also requires the clinical judgment of a physician, who will arrange for further examinations.
It cannot be diagnosed solely by CT or MRI.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2022/01/19

More Info

Understanding right lower abdominal pain can be complex, as it can arise from various causes, particularly in women, where gynecological issues often take precedence. Given your history of recurrent pain in the right lower abdomen, along with the results from your previous imaging studies, it is essential to consider several potential diagnoses and the appropriate diagnostic approaches.

1. Potential Causes of Right Lower Abdominal Pain:
- Appendicitis: Although your CT scan did not show evidence of appendicitis, it is one of the most common causes of right lower abdominal pain. The absence of inflammation in the appendix on imaging is reassuring.

- Mesenteric Inflammation: Your CT report indicated mild stranding of the mesentery, suggestive of nonspecific mesenteric inflammation. This could be due to various factors, including infection, inflammatory bowel disease, or even post-surgical changes if you have had any abdominal surgeries in the past.

- Diverticulitis: While your report mentioned no diverticula, diverticulitis can sometimes present with similar symptoms and may not always be visible on imaging.

- Irritable Bowel Syndrome (IBS): Given your symptoms of bloating and discomfort, IBS could be a consideration, especially if your symptoms fluctuate with stress or dietary changes.

- Crohn's Disease: Your concern about Crohn's disease is valid, particularly given your symptoms and the presence of skin allergies. Crohn's can sometimes be challenging to diagnose in its early stages, as it may not always show up on imaging or blood tests.

2. Diagnostic Approaches:
- Endoscopy: To definitively diagnose conditions like Crohn's disease or other inflammatory bowel diseases, a colonoscopy (for the colon) and possibly an enteroscopy (for the small intestine) would be beneficial. These procedures allow direct visualization of the intestinal lining and the ability to take biopsies if necessary.

- Imaging Studies: While CT scans and MRIs can provide valuable information about the abdominal organs, they may not always reveal early-stage inflammatory bowel disease. Endoscopic evaluations are often more definitive.

- Blood Tests: Regular monitoring of inflammatory markers (like CRP) and specific tests for Crohn's disease (such as anti-Saccharomyces cerevisiae antibodies, or ASCA) can also provide additional insights.

3. Other Considerations:
- Gynecological Issues: Since you are experiencing pain in the lower abdomen, it is crucial to rule out any gynecological conditions such as ovarian cysts, endometriosis, or pelvic inflammatory disease. A pelvic ultrasound or gynecological examination may be warranted.

- Functional Disorders: Anxiety and stress can exacerbate gastrointestinal symptoms. If you have a history of anxiety, addressing this through counseling or stress management techniques may also help alleviate some of your symptoms.

4. Conclusion:
Given your ongoing symptoms and the complexity of potential causes, it is advisable to follow up with a gastroenterologist for further evaluation. They may recommend endoscopic procedures to obtain a definitive diagnosis. Additionally, maintaining a symptom diary that tracks your pain, dietary habits, and stress levels can provide valuable information for your healthcare provider.

In summary, while imaging studies like CT and MRI are useful, they may not always provide a complete picture, especially for conditions like Crohn's disease. A combination of endoscopic evaluation, blood tests, and possibly further imaging will help clarify the underlying cause of your symptoms. It is essential to work closely with your healthcare team to ensure a thorough investigation and appropriate management of your condition.

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