Persistent Right Lower Abdomen Lump: Seeking Medical Guidance and Non-Radiation Tests

There is a palpable mass in the right lower abdomen?

Hello Doctor, my question is about a lump I can feel in my lower right abdomen (approximately 6-7 cm to the right of the navel and 5-6 cm down).
I experience dull pain when I have the urge to defecate or urinate, and there is also a feeling of pressure and pain in my right bladder and right pubic bone.
Additionally, my right lower back feels sore, and I experience pressure and tenderness in my right groin when sitting.
The symptoms improve somewhat when standing, but discomfort returns when lying down or sitting.
This pain has persisted since October 2014.
I have sought medical attention multiple times, including visits to the emergency room where blood tests, urinalysis, X-rays, and a CT scan were performed, ruling out appendicitis.
However, the doctor noted a shadow in the abdominal wall and muscle area, suggesting I see a general surgeon.
I visited a general surgeon (who previously performed surgery for a hernia) who mentioned that the pain could be due to scar tissue, but that surgery was performed 6-7 years ago and the distance from the hernia incision is 7 cm.
The surgeon was unsure why I am experiencing pain now and suggested observation, referring me to a hepatobiliary and gastroenterology specialist.
Blood tests showed normal white blood cell counts, X-rays appeared normal, and an ultrasound was performed, but the lump could not be visualized.
I was then referred to a colorectal surgeon.
The colorectal surgeon stated that since I had a colonoscopy in May, it is unlikely for the colon to develop cancer so quickly, and all necessary tests have been completed.
He mentioned that the issue may be related to inflammation in the abdominal wall muscles, and no department was willing to admit me, which is why I was referred to colorectal surgery.
The dull pain in my lower right abdomen continues, along with persistent pressure and pain in my right bladder, pubic bone, and groin, causing me significant distress and sleepless nights.
Most of my tests have been conducted at Mackay Memorial Hospital, and I am unsure which department to consult next or if I should switch hospitals for a reevaluation.
I would appreciate your advice on which specialty I should see next or if I should consider changing hospitals for further examination.
Since July 2014, I have been experiencing discomfort in my neck, leading to two CT scans of the neck, one PET scan for thyroid evaluation, and over ten X-rays.
In October, I discovered the lump in my lower right abdomen, which resulted in an abdominal CT scan and over ten additional X-rays.
I feel that the radiation exposure is becoming excessive, yet the cause of my symptoms remains undetermined.

Could you please advise if there are non-radiation-based diagnostic methods, such as MRI or other alternatives? Additionally, I would like to know if other non-radiation tests would be helpful in identifying the cause of the abdominal lump.
Thank you for your assistance!

Alen, 30~39 year old female. Ask Date: 2015/01/07

Dr. Gao Qingyun reply Family Medicine

Dear Alen,
I generally agree with the assessment made by the previous physician regarding your symptoms; however, a physical examination is necessary for a detailed evaluation.
The medical examination process involves taking a comprehensive medical history and conducting a thorough physical examination to arrive at a preliminary diagnosis.
This is then confirmed through a limited number of appropriate diagnostic tests, rather than patients randomly seeking tests based on their own assumptions.
I recommend that you visit a general surgery outpatient clinic at a medical center for further assistance.
Wishing you health and safety,
Dr.
Gao Qingyun
Director, Department of Family Medicine
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2015/01/07

More Info

It sounds like you are experiencing a challenging and distressing situation with the persistent lump in your right lower abdomen, along with associated pain and discomfort. Given the complexity of your symptoms and the extensive evaluations you've already undergone, it is understandable that you are seeking further guidance and potential non-radiation testing options.

From your description, it appears that you have already consulted multiple specialists, including emergency medicine, general surgery, and gastroenterology, and have undergone various imaging studies such as CT scans and ultrasounds. The fact that these tests have not provided a definitive diagnosis can be frustrating, especially when you are experiencing ongoing pain and discomfort.

Non-Radiation Testing Options
1. MRI (Magnetic Resonance Imaging): MRI is an excellent non-radiation imaging modality that can provide detailed images of soft tissues, organs, and structures within the abdomen. It is particularly useful for evaluating abdominal masses, inflammation, and other abnormalities that may not be visible on CT scans or ultrasounds. An MRI could help clarify the nature of the lump you are feeling and assess any associated structures.

2. Ultrasound: While you mentioned that an ultrasound did not capture the lump, it is worth noting that ultrasound is operator-dependent. If the initial ultrasound was inconclusive, seeking a second opinion or a more specialized ultrasound may yield different results. This imaging technique is safe, non-invasive, and does not involve radiation.

3. Endoscopy: Depending on your symptoms, a gastroenterologist might consider performing an endoscopic procedure, such as a colonoscopy or an upper endoscopy, to directly visualize the gastrointestinal tract. This could help rule out any underlying gastrointestinal issues that may not have been detected in previous evaluations.

4. Biopsy: If a mass is identified and its nature remains uncertain, a biopsy may be warranted. This can often be done via ultrasound or CT guidance to obtain tissue samples for histological examination.

Next Steps
Given your ongoing symptoms and the lack of a clear diagnosis, it may be beneficial to consider the following steps:
- Consult a Specialist: If you have not already done so, consider seeing a specialist in abdominal pain or a surgical oncologist who can provide a fresh perspective on your case. They may have additional insights or recommendations for further evaluation.

- Seek a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another hospital or medical center may be beneficial. Different institutions may have access to different resources or specialists who can provide further insights.

- Document Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any factors that alleviate or exacerbate them. This information can be invaluable for your healthcare provider in making a diagnosis.

- Discuss Non-Radiation Options: When you meet with your healthcare provider, express your concerns about radiation exposure and inquire specifically about non-radiation imaging options like MRI or further ultrasound evaluations.

Conclusion
Navigating persistent abdominal symptoms can be challenging, especially when previous evaluations have not yielded clear answers. Exploring non-radiation imaging options like MRI and seeking further consultations with specialists may provide the clarity you need. Remember, advocating for your health and seeking the answers you deserve is crucial. Don't hesitate to express your concerns and preferences to your healthcare team as you continue your journey toward understanding and addressing your symptoms.

Similar Q&A

Understanding Right Lower Abdominal Mass: Symptoms and Diagnosis

Hello, doctor. Over the past year, I have been experiencing bloating, pain, and diarrhea in my lower right abdomen, occurring approximately once every 3-5 months. I have visited several clinics, and they seem to think it is irritable bowel syndrome, as I have medical records. I a...

Dr. Chen Shidian reply Gastroenterology and Hepatology
A colonoscopy is necessary to confirm the absence of colorectal cancer. A negative fecal occult blood test does not rule out colorectal cancer, so if there are concerns, it is advisable to discuss them with a physician.

Exploring Non-Radiation Imaging Options for Abdominal Mass Evaluation

Thank you for your response, Doctor. 1. If you can feel the lump, can the physician also feel it? The surgeon and gastroenterologist can feel it, but they also said they are unsure what it is. 2. The ultrasound did not detect anything. The doctor at National Taiwan University ...

Dr. Chen Sirong reply Oncology
If you are still afraid of cancer, Alen, you can choose option A: a CT scan and a colonoscopy, or option B: a self-paid PET scan costing between 30,000 to 50,000 NTD. You had an abdominal CT scan in October and a colonoscopy in May, so the doctor is suggesting another test. The q...

Understanding Right Lower Abdominal Pain: Causes and Diagnostic Approaches

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 examinatio...

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. C...

Unexplained Lump in Lower Abdomen: What You Need to Know

Recently, I suddenly noticed a small, firm lump on the right side of my lower abdomen, near the junction with my thigh. It feels raised but is not painful to the touch. I'm unsure what it could be and which specialist I should consult. Thank you.

Dr. Cai Dongqi reply Family Medicine
It could be lymphadenopathy; please consult a general internist or family medicine physician first.