Lower Right Abdominal Pain

by Nicole
(Wyoming)

Hello. I am a 24 year old female. This all started in September with diarrhea and vomiting with non-specific abdominal pain. I had seen my regular doctor and she thought it was a virus. As the pain got worse I ended up in the ER. The pain was achy pretty much all over my abdomen, but got much worse toward the lower right. They did a CT. The ER docs told me I was constipated. I found this odd since I had been having a lot of diarrhea. They did do a colonoscopy with in the week which of course cleaned me out. They were looking for chrons disease as this runs in the family. Nothing was found.

After being cleaned out for the colonoscopy, I felt ok for a week or so, until the pain came back again even worse than before. No diarrhea this time, but nausea and vomiting continued. I called my doctors office and was instructed to go back to the ER. Again the pain was focused on the lower right side but some aches all over. Another CT later and I was told I was again constipated despite upping my fiber contents and having regular bowel movements. I guess they weren't large enough? So I went a round with Mag. Citrate. At first it didn't even work. I waited until the next morning with no results. I had an enema and took more, this time it produced results.

I felt better for a few days, but not long. The pain came back suddenly at night. I felt what I can only describe as what felt like something tore inside of me. It woke me up screaming. The pain didn't stay that bad and did subside enough I could sleep. When I woke up the next morning the pain was still there and got worse when I moved. I could hardly walk as when I put pressure on my right leg my right lower abdomen felt horrible. This was yesterday. I called my regular doctor and she got me in right away. After her exam she was pretty sure it was my appendix. She got me in for a CT. Nothing was wrong with the appendix. They did say there were loops of bowel filled with fluid and some air and again, stool backed up. Again, I have had regular bowel movements and started taking MeraLax daily. I don't know that constipation would cause this much pain.

My galbladder is being tested today and a gastric emptying test is scheduled for later in the week. Is there anything else we should be looking for? I can't stand the pain anymore. I keep missing work, my boss has been understanding about it, but it is driving me crazy. I spend most days in my bed because moving hurts too bad. I am searching for answers. Any ideas would be appreciated.

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Hi Nicole,

What a journey in pain and uncertainty you've been through ... and still on. I am so sorry to learn about your experience.

From the constellation of symptoms described, it very well sound to me that what you have is a condition called epiploic appendagitis, also called appendicitis epiploica or epiplopericolitis.

Epiploic appendagitis is a rather very common cause of lower right abdominal pain first described by a leading surgeon in 1853, but for some strange reason, that has not been well embraced, though known to be a scientifically correct and common cause of abdominal pain.

Surrounding our colons, are about 100 or so finger-like protrusions measuring about 3cm or more each. Following a recurrent infection, or blockade to their blood supply or tangling, they become inflamed and are one of the most common mimickers of acute appendicitis. They usually resolve on their own and very rarely lead to any significant complications.

What I believe happened in your case is this:

• You had a bad constipation first time with what we call over-flow diarrhea and needed colonoscopy as well as bowel cleaning. That in it self could cause inflammation of your bowels - large bowels)
  
  
• You then developed some bowel stasis or slowing down, another episode of constipation and then
  
  
• Inflammation of the appendages of the colon - called epiploic appendagitis.

This might have resulted from previous inflammation been stroked up or from twisting of the epiploic appendages themselves, causing that severe pain, bending over and looking like you've got appendicitis. That all your tests for appendicitis came back normal makes this more plausible.

The good news is that, if this pain is due to epiploic appendagitis, it will get better on its own with taking regular ibuprofen or diclofenac, if there are no contraindications to your taking such.

Epiploic appendagitis is a very common reason for having unnecessary operation for a supposedly bad appendix. This diagnosis can be made on CT scan IF the radiologist looked for it. You can discuss this possibility with your doctor and see what he or she thinks. You can read more on Epiploica appendagitis here.

Give it a few days or a week more, and things should settle down. If your symptoms are worsening though, please do not hesitate to go back to the ER.

We will be most grateful if you could please come back to update us on how things went and if an alternate diagnosis was made and treatment received. This will no doubt immensely help to broaden our horizon in understanding such a painful experience like you've had.

Thank you so much Nicole for taking the time to share your experience here at abdopian.com and we sincerely wish you a speedy recovery.

Good Health To You.

Dr Edema
Abdopain.com