Persistent Abdominal Pain: Navigating Complex Gynecological Issues

Pain that cannot be alleviated?

My girlfriend has been experiencing severe pain around her navel for the past month and a half.
She has visited many hospitals.
In March of this year, she had a right-sided ruptured corpus luteum at Linkou Chang Gung Memorial Hospital, where she was observed for a day and given a hemostatic injection.
Due to continuous bleeding, she underwent surgery and stayed in the hospital for four days.
After discharge, she had no pain issues, and her wound healed well.
In August, she was hospitalized for a week due to intestinal obstruction at Taoyuan Hospital, and after resolving the issue, she was discharged smoothly.
In mid-November, she had a bilateral ruptured corpus luteum with a blood loss of 500cc within an hour, which was very urgent.
She underwent surgery at Zhongli Hospital and stayed for four days.
However, since her discharge in mid-November, the pain has persisted and even worsened.
During follow-up visits, the doctor only prescribed strong painkillers, stating that the wound was healing well and that she could rest at home.
However, the management of her case was not as thorough as at Chang Gung.
By early December, the pain intensified, prompting her to visit the gynecology department at Linkou Chang Gung, where she underwent blood tests, abdominal ultrasound, vaginal ultrasound, and CT scans.
It was found that there was bleeding from the left corpus luteum but no rupture.
She received a hemostatic injection and was hospitalized for a week, but the pain continued.
She needed to administer morphine or similar pain relief almost every six hours, and sometimes the pain would return in three to four hours.
By December 9, the bleeding had stopped, but she still experienced severe abdominal pain.
The gynecologist could not identify the cause, so she was referred to the gastroenterology department.
On December 13, she visited the hepatobiliary and gastroenterology department at Taoyuan Hospital and was hospitalized for two weeks.
She underwent abdominal X-rays, brain CT scans, abdominal CT scans, colonoscopy, gastroscopy, blood tests, vaginal ultrasound, and abdominal ultrasound.
Tests for HIV and syphilis were negative, but they found gastric erosion and some ulcers in the duodenum.
During her two-week hospital stay, she continued to experience pain and received morphine and similar pain medications.
However, Primperan caused her to develop severe extrapyramidal symptoms (EPS).
By December 30, the erosions had healed, but the severe pain persisted.
The hospital then referred her to Taipei Tzu Chi Hospital to check for any issues related to purpura.
Further tests returned negative results, but they discovered pelvic inflammation, urethritis, ruptured corpus luteum bleeding, and intestinal adhesions.
After waiting several days for a hospital bed, she was transferred to Taipei Shuang Ho Hospital for treatment.
She has been hospitalized there for a week, receiving antibiotics and hemostatic injections, and X-rays were performed since previous tests had been documented.
No additional tests were conducted, but the pain remains severe.
Currently, she is still receiving morphine or other pain relief every six hours or even sooner with out-of-pocket medications.
The doctors have been unable to identify the cause and do not recommend surgery due to concerns about potential bowel rupture or adhesions, fearing that surgery might not reveal any significant issues.
Given her current situation, what further treatment options are available? Thank you.

Xiao Zhi, 20~29 year old female. Ask Date: 2023/01/05

Dr. Huang Yuande reply Obstetrics and Gynecology

It sounds quite complex.
Generally, the rupture of a corpus luteum cyst is not uncommon.
Is there a possibility of intestinal injury occurring during or after surgery? Or could it be due to the patient's constitution leading to severe adhesions? This requires clinical judgment.
The likelihood of recurrent corpus luteum rupture seems low unless there is a coagulopathy.
In addition to intra-abdominal issues, please consider whether there is nerve damage in the abdominal wall or involvement of the pelvic nerves as a cause of abdominal pain.
The above are all speculations, and a comprehensive clinical evaluation should be sought.

Reply Date: 2023/01/05

More Info

Persistent abdominal pain, especially in the context of complex gynecological issues, can be a challenging and frustrating experience for both the patient and the healthcare providers involved. Your girlfriend's situation, characterized by a history of ruptured ovarian cysts, bowel obstruction, and ongoing severe pain despite extensive medical evaluations and treatments, requires a careful and comprehensive approach to diagnosis and management.

Firstly, it is essential to understand that abdominal pain can arise from various sources, including gynecological, gastrointestinal, urological, and even musculoskeletal systems. Given your girlfriend's history of ruptured corpus luteum cysts and the recent findings of pelvic inflammatory disease and bowel adhesions, it is crucial to consider both the gynecological and gastrointestinal aspects of her pain.

1. Gynecological Considerations: The presence of pelvic inflammatory disease (PID) can lead to chronic pain due to inflammation and scarring in the pelvic region. Additionally, the history of ruptured cysts may have caused adhesions, which can contribute to ongoing pain. While the surgical interventions may have addressed immediate concerns, the development of adhesions is a common complication that can lead to chronic abdominal pain. It is also important to consider other gynecological conditions such as endometriosis, which can cause significant pain and may not always be evident on imaging studies.

2. Gastrointestinal Factors: The history of bowel obstruction and the recent findings of gastrointestinal issues, including gastric erosions and ulcers, cannot be overlooked. These conditions can cause referred pain to the abdominal area and may complicate the clinical picture. The use of strong analgesics like morphine can mask underlying gastrointestinal symptoms, making it challenging to assess the true nature of the pain. It is essential to ensure that gastrointestinal issues are adequately managed, as they can significantly impact overall health and pain perception.

3. Multidisciplinary Approach: Given the complexity of your girlfriend's case, a multidisciplinary approach may be beneficial. This could involve collaboration between gynecologists, gastroenterologists, pain specialists, and possibly even psychologists or psychiatrists to address any underlying anxiety or stress that may exacerbate her pain. Chronic pain can often have a psychological component, and addressing mental health may improve her overall well-being and pain management.

4. Further Investigations: If the pain persists and no clear diagnosis has been established, further investigations may be warranted. This could include advanced imaging techniques such as MRI, which may provide better visualization of soft tissues and potential adhesions or endometriosis. Additionally, a diagnostic laparoscopy could be considered if non-invasive methods do not yield conclusive results, allowing direct visualization of the pelvic organs.

5. Pain Management: While strong opioids may provide temporary relief, they are not a long-term solution due to the risk of dependency and side effects. Exploring alternative pain management strategies, including physical therapy, nerve blocks, or even integrative approaches such as acupuncture or mindfulness-based stress reduction, may offer additional relief.

6. Patient Advocacy: It is crucial for you and your girlfriend to advocate for her health. If she feels that her concerns are not being adequately addressed, seeking a second opinion or consulting a specialized pain management clinic may provide new insights and treatment options.

In conclusion, your girlfriend's persistent abdominal pain is likely multifactorial, involving both gynecological and gastrointestinal components. A thorough and collaborative approach, focusing on both physical and psychological aspects of her health, will be essential in navigating her complex medical history and improving her quality of life. It is important to remain proactive in seeking answers and advocating for her health as she continues her journey toward recovery.

Similar Q&A

Persistent Abdominal Pain for Over a Month: Seeking Answers

Hello doctor, I have been experiencing abdominal pain for over a month. I have undergone examinations in gynecology, gastroenterology, and orthopedics, and everything came back normal. The tests I have had include a Pap smear, vaginal ultrasound, abdominal ultrasound, urinalysis,...

Dr. Xiao Yongxun reply Family Medicine
Dear Ms. Ake: 1. Abdominal pain is inherently challenging in clinical practice due to the wide range of organs and systems involved. 2. Taking upper abdominal pain or discomfort as an example, common diagnoses include gastric ulcers or gastritis, duodenal ulcers or duodenitis, ...

Understanding Side Abdominal Pain: When to Seek Medical Help

Hello Doctor: I have been experiencing mild pain on both sides of my abdomen for four months. Both gynecological and urological examinations have shown no issues. I am unsure what the problem might be. Which specialist should I see?

Dr. Chen Fuhao reply Obstetrics and Gynecology
Dear Ms. H.S.Y: Abdominal pain is a common issue faced by women and is a significant source of distress. It can lead not only to physical ailments but also to psychological burdens. For women experiencing abdominal pain, it is crucial to identify the exact cause and implement ap...

Persistent Lower Abdominal Pain: Navigating Urology and Beyond

Lower abdominal pain, sometimes accompanied by pain in the genital area and anus, and at times causing a frequent urge to urinate, has persisted for a year. I previously visited a urologist who conducted urine tests and bladder and kidney ultrasounds, and the doctor said there we...

Dr. Xu Weikai reply Urology
Hello, you may need to visit a medical center for further examination if there are any unclear issues. Feel free to ask again for further discussion and research. Answers found online should only be used as a reference; it is essential to seek medical care at a healthcare facilit...

Understanding Pelvic Pain: Causes, Diagnosis, and Treatment Options

Since August and September, I have been experiencing aching pain in the pelvic area. I have undergone many tests with no results, and the doctor finally diagnosed me with pelvic congestion syndrome. Additionally, I have developed neuropathy in two nerves, but there has been no im...

Dr. Wu Zongcheng reply Obstetrics and Gynecology
1. Unexplained lower abdominal pain is challenging to manage, and general practitioners often rely on subjective diagnoses. Although laparoscopic procedures may be performed, they do not always address the underlying issue, leading to persistent pain. 2. The fundamental approac...