Managing Persistent Abdominal Discomfort After Surgery: Next Steps - Gastroenterology and Hepatology

What should I do?

---

Hello Dr.
Tsai,
Medical history description: In February 2012, I experienced severe cramping pain in my abdomen (primarily on the left side, with no diarrhea or vomiting).
I went to the emergency department of Hospital A, where I underwent blood tests, urinalysis, ultrasound, and CT scans.
The physician diagnosed me with small bowel inflammation and I was hospitalized for treatment (receiving antibiotics) for about four days before being discharged; I was prescribed antibiotics to take for a week.
In March of the same year, I experienced similar symptoms (this time with severe cramping pain in the lower abdomen, again with no diarrhea or vomiting) and returned to the emergency department of Hospital A.
I underwent blood tests, urinalysis, stool tests, ultrasound, and CT scans, and was again diagnosed with small bowel inflammation and swelling.
I was hospitalized for about five days and discharged with a week's worth of antibiotics.
During a follow-up visit, I asked the physician about the cause of the recurrent inflammation, and the physician suggested it might be due to an allergy to something (I have no history of allergies and have not taken any medications).
In June of the same year, the same symptoms occurred again (this time the cramping was also in the lower abdomen).
I went to the emergency department of Hospital B, where I underwent similar tests (including a CT scan).
This time, I was not hospitalized but received pain relief and IV fluids in the observation area.
After staying in the observation area for about 13-14 hours without seeing a physician to explain the issue, I informed the nurse that I wanted to be discharged, which was agreed upon, and I was given medication.
However, upon reviewing the medication, I noticed it was for urinary tract and bladder inflammation (as indicated on the medication bag).
After being discharged from Hospital B, I felt something was off about the medication they prescribed, so I did not take it.
Although the pain had somewhat diminished, my abdomen still felt very uncomfortable, so I returned to Hospital A for an outpatient visit.
This time, I consulted a different physician and described my symptoms.
Only blood tests were performed, and the results showed elevated white blood cells and inflammatory markers.
The physician suggested I undergo a small bowel endoscopy due to the recurrent inflammation, but since that hospital did not have the necessary equipment, I was referred to a larger hospital.
I then requested my medical records and went to Hospital C for examination.
At Hospital C, the gastroenterologist reviewed my symptoms and the previous CT images from Hospital A, confirming that my small intestine appeared severely swollen and likely inflamed.
The physician arranged for a barium swallow study, which indicated abnormalities in the small intestine in the right lower abdomen (near the colon, where the intestinal wall appeared somewhat obstructed, resembling a segment that seemed partially obstructed).
Subsequently, the physician arranged for a small bowel endoscopy, but only about 6 cm could be examined due to a sharp bend in that area.
A CT scan was then performed, revealing abnormalities in the right lower abdomen near the bladder, and I was advised to see a surgeon (to obtain tissue for biopsy).
The internist suspected I might have inflammatory bowel disease or Crohn's disease, emphasizing "possibly." I then visited the surgical outpatient department, where the surgeon diagnosed me with an appendiceal cyst and performed laparoscopic surgery for removal.
The pathology results were benign, and I was informed that no further follow-up was necessary (this was in December 2012).
Question: Since the surgery, although I no longer experience severe cramping pain, I still often feel discomfort in my abdomen, such as mild cramping or a dull ache (in the right lower abdomen, lower abdomen, and left abdomen).
Additionally, I can distinctly feel a hard mass in the right lower abdomen, which becomes more pronounced and harder when gas moves through the abdomen (the mass measures approximately 5x2 cm).
This condition existed before the surgery, and I informed the internist at Hospital C about it.
Since the onset of small bowel inflammation, my bowel movements have consistently been soft or loose, never solid.
(I also informed the physician at Hospital C, and stool tests showed no abnormalities).
My weight has remained stable without any loss.
I would like to ask the physician for advice regarding my current condition.
Given that I have undergone so many tests previously, what should I do next? Should I return to the previous hospital for an outpatient visit? It has been quite a journey, and I have already communicated my symptoms to the physician at Hospital C.
I hope the physician can provide me with some suggestions! (I apologize for the lengthy message, but I wanted to clearly describe my medical history and treatment experiences.) Thank you!

---

Mr. Hsu, 30~39 year old female. Ask Date: 2013/06/18