Abdominal Hard Tissue: When to Seek Further Medical Evaluation

Abdominal hard tissue

Hello, doctor.
I would like to ask if it is necessary for me to undergo further examinations.
At the beginning of September, I sought medical attention due to persistent dull pain in the lower right abdomen, which was not very severe—about 1/10 of the pain of a typical cramp.
Sometimes, I experience a cramping sensation in that area.
I underwent blood tests, X-rays, a general stool examination, and an abdominal ultrasound, all of which returned normal results.
However, the stool occult blood test showed a trace result.
The doctor mentioned that the X-ray revealed a significant amount of residual stool in my abdomen, and since I am not overweight (170.58 cm), what I am feeling might be stool retention.
I have a regular bowel movement routine every day.
However, while bathing, I can feel a firm mass about 2x2 cm in size, located one centimeter to the right of my navel, which is hard and does not move when pressed.
This makes me very concerned that it could be a malignant tumor.
I would also like to ask the doctor: if it were a malignant tumor, would there definitely be blood in the stool? Because upon visual inspection, my stool appears to have some light red pieces that look like undigested carrots, but there is no black or bloody discoloration in the toilet.
If there is a hardened mass, would it not be detected at all on the abdominal ultrasound? Given that the aforementioned tests have returned normal results, should I not worry too much, or do you still think I should undergo a colonoscopy or other examinations? Thank you, doctor.

Zeng, 20~29 year old female. Ask Date: 2022/10/28

Dr. Ke Fangxu reply Surgery

The so-called hardened tissue cannot provide a possible answer without a personal examination.
However, at this age, it is mostly likely a benign subcutaneous tumor.
Abdominal ultrasound generally does not pay much attention to subcutaneous tissue.
Malignant tumors do not necessarily bleed at all times, and there is also the possibility of false negatives in examinations.
Although the likelihood of developing colon cancer at the age of 24 is not zero, it is generally very, very low.
It is recommended to maintain a light diet and good lifestyle habits.
If there are still uncomfortable symptoms or if there is significant concern, you can ask your physician to arrange for a colonoscopy.

Reply Date: 2022/10/28

More Info

When it comes to abdominal hard tissue and persistent discomfort, it is essential to approach the situation with a thorough understanding of the potential underlying causes and the appropriate steps for further evaluation. Based on your description, you have already undergone several diagnostic tests, including blood tests, X-rays, stool tests, and abdominal ultrasound, all of which returned normal results except for a trace of occult blood in your stool. This is a good initial step, but your ongoing symptoms and the palpable hard tissue warrant further consideration.

The presence of a hard mass in the abdomen, especially one that is firm and non-mobile, can be concerning. It is crucial to differentiate between benign conditions, such as fibrous tissue or residual stool, and more serious conditions, including tumors. The fact that you have a history of abdominal discomfort and the specific location of the hard tissue could suggest a few possibilities. It could be a benign condition like a lipoma (a benign fatty tumor), a hernia, or even a post-surgical scar tissue if you have had previous abdominal surgeries. However, the concern for malignancy should not be dismissed outright, especially given your anxiety about the situation.

Regarding your question about whether a malignant tumor would always present with blood in the stool, the answer is no. While gastrointestinal tumors can cause bleeding, not all tumors will lead to visible blood in the stool. Some tumors may be small or located in areas that do not cause overt bleeding, especially in the early stages. The trace of occult blood you mentioned could be due to various benign causes, including dietary factors or hemorrhoids, but it does warrant attention.

As for the abdominal ultrasound, while it is a useful tool, it may not always detect small masses or certain types of tumors, particularly if they are located in challenging areas or if they are not well-defined. If the ultrasound did not reveal any abnormalities, it does provide some reassurance, but it does not completely rule out the possibility of a significant issue.

Given your symptoms and the palpable hard tissue, it would be prudent to consider further evaluation. A colonoscopy could be beneficial, especially since you have a trace of occult blood in your stool. This procedure allows for direct visualization of the colon and rectum, and it can also enable the physician to take biopsies if any suspicious lesions are found. Additionally, if the hard tissue persists or if your symptoms worsen, further imaging studies, such as a CT scan of the abdomen, may be warranted to provide a more comprehensive view of the abdominal structures.

In conclusion, while your initial tests have returned normal results, the presence of a hard mass and ongoing discomfort suggests that further evaluation is necessary. Discuss your concerns with your healthcare provider, who can assess your situation in detail and recommend the most appropriate next steps, which may include a colonoscopy or additional imaging studies. It is always better to err on the side of caution, especially when it comes to potential abdominal issues. Your health and peace of mind are paramount, so do not hesitate to seek further evaluation if you feel it is necessary.

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