pain in right lower quadrant with nausea and vomiting

by mother of patient

pain in right lower quadrant with nausea and vomiting with movement. Area tender to touch. this has been ongoing since 4/18/11 . CT shows normal appendix. 2 different blood tests, first 17,000 now at 7,000. abdominal xray normal. Pain described as stabbing always constant but level is worse at times. no fever. BP 90/55. Pelvic ultrasound shows some ovarian cysts with no pain. Inter muscular steroid injection given with no relief.Patient is 33 year old female. Any suggestions?




Hello There,

It's one of the doctors from the abdominal pain team here. Thanks for using our free online discussion forum.

There is clear evidence there that some form of inflammation had occurred, which is now clearing off as shown by the blood count (CBC) of 17,000 now down to 7,000.

It is most likely a case of local inflammation of the colon (cecum) that could have been caused by a brief cecocolic torsion with ischaemia or from a localized bout of inflammatory colitis.

Is there any family history of inflammatory bowel disease like ulcerative colitis?

It's a shame that the pain is still there, but it is very probable that in the next few days things should be getting better.

Most of the time, a cause of abdominal pain will never be found. The most important thing in all cases is to exclude potentially dangerous causes of the pain. Having been seen by a doctor, had CT scan as well as ultrasound scan, coupled with improving blood results, it seems things can only get better.

If in the next 3 to 5 days she is not better, she would need a re-evaluation.

I hope this helps. Please do not hesitate to come back to us again, should you have any other specific questions.

Abdopain Team.

Comments for pain in right lower quadrant with nausea and vomiting

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Aug 15, 2012
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starstarstarstarstar 		stomach pain at right side
by: Anonymous

i have a severe pain at lower part of my right side stomach,when the pain start my backbone and neck use to pain alot.itz been more then one year that i am having this problem,please suggest me
Sep 07, 2011
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starstarstarstarstar 		Right lower quadrant pain
by: Anonymous

Hi was hoping for someone's thoughts.
14 year old female
3 week history of lower right quadrant pain
Nausea, fever 38c , reduced pain on rest increased on walking.
WBC normal, u's and e's normal
Ultrasound normal ( includes kidney, ovary, bladder etc)
Increasing feeling of unwellness and temp only in the evenings.
Appendicitis has been ruled out because of WBC .
Thank you.
Jun 27, 2011
Rating
starstarstarstarstar 		patient cured
by: Anonymous

the final diagnosis was indeed acute appendicitis. we went back to the original ob gyn doctor who made the first diagnosis. without relying only on the cat scan and wbc he relied on the symptoms as they presented and was willing to go forward with the surgery. Only being a persistent patient advocate willing to go outside the HMO were we able to get this situation fixed. The patient has completely recovered.

thank you for your comments.
Jun 27, 2011
Rating
starstarstarstarstar 		Recurrent Cecocolic Torsion
by: FTTirol, M.D.

Suggest:
1. Perform positional contrast Gastrografin (water soluble) or even Barium enema to define the cecocolic mobility.
2. Refer your physician or surgeon to the articles on the Classification of and Radiological diagnosis of Cecocolic torsion in this same GOOGLE page, for a comprehensive review of diagnosis and treatment.
3. Note:
a.WBC elevation is a nonspecific response to an acute stress.
b.Ultrasound = a useful tool only "rarely"
c.Nausea and Vomiting = could be reflex

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