Lower Abdominal Pain: Causes and Diagnostic Challenges

Lower abdominal pain, sharp pain radiating downwards, and rebound tenderness upon palpation?

Hello, doctor.
On June 9th, I experienced severe abdominal distension and pain that was so intense I could not tolerate palpation.
A CT scan revealed a large number of lymph nodes.
To rule out the possibility of a tumor, the physician performed a colonoscopy.
The attending doctor indicated that the level of ulcerative inflammation would not cause such widespread abdominal pain; however, my inflammatory markers skyrocketed to 200.
I was hospitalized for a week and received antibiotics (Floxacillin), but the levels did not decrease.
Three days after discharge, my inflammatory markers remained above 100.
The gastroenterologist suspected it was not a gastrointestinal issue (the discharge diagnosis was diverticulitis), so I was referred to gynecology for further evaluation.
I underwent a pelvic ultrasound and vaginal culture, which showed E.
coli.
Due to the pain being unbearable, I was readmitted for three days of antibiotics (Ceftriaxone).
After discharge, I still experienced pain, but my inflammatory markers finally dropped to 2.
Throughout this time, my white blood cell count has remained normal, and both urination and bowel movements have been normal (though with some urgency and heaviness).
Currently, I have sharp pain in my lower abdomen, rebound tenderness, and severe pain in the upper abdomen with cramping and distension, as well as pain in the left side of my abdomen extending to the lower left.
What should I do, doctor? Both gynecology and gastroenterology have been unable to identify the cause.
My last menstrual period was on June 7th.

Ping Er, 30~39 year old female. Ask Date: 2023/07/03

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Online consultations cannot provide a diagnosis; it is advisable for you to return for an in-person evaluation.
Thank you.

Reply Date: 2023/07/03

More Info

Understanding lower abdominal pain can be quite complex, especially when multiple diagnostic tests fail to pinpoint the exact cause. Your situation, characterized by persistent abdominal pain, elevated inflammatory markers, and a history of extensive testing, raises several important considerations.

Firstly, it’s crucial to recognize that lower abdominal pain can stem from a variety of sources. Common causes include gastrointestinal issues (like diverticulitis, which you were diagnosed with), gynecological conditions (such as ovarian cysts or endometriosis), urinary tract infections, and even musculoskeletal problems. Given that your pain has persisted despite treatment and that your inflammatory markers remain elevated, it suggests that there may be an underlying condition that has not yet been identified.

The fact that your CT scan revealed enlarged lymph nodes is particularly noteworthy. Enlarged lymph nodes can indicate an inflammatory process or infection, but they can also be associated with malignancies. While your doctors have ruled out tumors through colonoscopy, it may be worthwhile to consider further imaging studies, such as an MRI or a PET scan, to assess the lymph nodes and surrounding tissues more thoroughly.

Your experience of severe pain during palpation, along with the rebound tenderness, suggests that there may be an acute inflammatory process occurring in the abdomen. This could be due to complications from diverticulitis, such as abscess formation or perforation, which can lead to peritonitis—a serious condition that requires immediate medical attention. If you experience any worsening symptoms, such as fever, increased pain, or changes in bowel habits, it is critical to seek emergency care.

In terms of the gynecological evaluation, conditions like pelvic inflammatory disease (PID) or ectopic pregnancy should be considered, especially since you mentioned that your last menstrual period was on June 7. If there is any possibility of pregnancy, a pregnancy test should be conducted to rule out ectopic pregnancy, which can present with similar symptoms.

Additionally, the presence of E. coli in your vaginal culture raises the possibility of a urinary tract infection or a related condition that may not have been fully addressed. It might be beneficial to consult a urologist to explore any potential urinary issues that could be contributing to your symptoms.

Given the complexity of your case, I recommend the following steps:
1. Follow-Up with Specialists: Continue to work closely with your gastroenterologist and gynecologist. If necessary, request referrals to other specialists, such as a urologist or an infectious disease expert, who may provide additional insights.

2. Further Imaging: Discuss the possibility of advanced imaging studies, such as an MRI or PET scan, to evaluate the lymph nodes and abdominal structures more comprehensively.

3. Monitor Symptoms: Keep a detailed log of your symptoms, including pain intensity, location, and any associated symptoms (like fever or changes in bowel habits). This information can be invaluable for your healthcare providers.

4. Consider a Multidisciplinary Approach: Sometimes, a multidisciplinary team approach can be beneficial. This may involve collaboration between gastroenterologists, gynecologists, and pain specialists to develop a comprehensive treatment plan.

5. Emergency Care: If your symptoms worsen or you develop new symptoms, do not hesitate to seek emergency medical care.

In conclusion, while the diagnostic process can be frustrating, persistent communication with your healthcare team and advocating for further evaluation is key to identifying the underlying cause of your abdominal pain. Your health is paramount, and ensuring that all potential avenues are explored will help in reaching a diagnosis and appropriate treatment plan.

Similar Q&A

Severe Lower Abdominal Pain: Possible Causes and Insights

Hello Dr. Lin, I have noticed that in recent years I have been experiencing severe pain in my lower abdomen (specifically about 5 centimeters below my navel). A few years ago, it occurred occasionally, perhaps once every few months, but over the past two and a half years, it has ...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Possible causes of lower abdominal pain include: 1. Gynecological issues (such as pelvic inflammatory disease, endometriosis, menstrual cramps, ovulation pain) 2. Gastrointestinal problems: poor gastrointestinal function, constipation, enteritis, diverticulitis, etc. 3. Urinary t...

Understanding Pancreatic Issues: Causes of Abdominal and Back Pain

Chronic lower abdominal pain that gradually extends to the pelvic area, along with left lower back pain, raises the question of whether pancreatic diseases can cause lower abdominal pain. Additionally, pain around the navel and left lower back pain are noted. An abdominal ultraso...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Hello: An abdominal ultrasound typically examines five organs: the liver, gallbladder, pancreas, spleen, and kidneys. However, a retroperitoneal ultrasound, located in the posterior abdominal cavity, is often affected by intestinal gas, making it more challenging to visualize. Ne...

Understanding Lower Abdominal Discomfort: Possible Gastrointestinal Issues

Hello, I have been feeling a sense of heaviness in my lower abdomen below the navel for the past few days, and occasionally I have the urge to have a bowel movement. There are no other unusual symptoms in my body. What could be the issue?

Dr. Lin Minghui reply Gastroenterology and Hepatology
Possible causes of lower abdominal discomfort: 1. Gastrointestinal issues, such as functional enteritis or fecal impaction. 2. Urinary tract problems, such as cystitis, where difficulty in urination can also lead to lower abdominal pain. If symptoms persist, follow up with a clin...

Understanding Right Lower Abdominal Pain: Causes and Treatments

Right lower abdominal pain.

Dr. Xu Ruihong reply Gastroenterology and Hepatology
There are many causes of right lower abdominal pain. The characteristics of the pain, accompanying symptoms, and duration are all important information for diagnosis. Several common differential diagnoses include: 1. Acute or chronic appendicitis 2. Functional gastrointestinal di...