Lower Right Abdominal Pain

by Nicole

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.

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

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Jan 04, 2013
Update- Pathology Results
by: Nicole

So the results are in and both the appendix and gallbladder were infected. I don't know why my white blood cell count never went up. I'm glad the appendix didn't end up rupturing and I didn't end up with gallstones.

Dollee, I agree with you. Sometimes serious illnesses get waved off as nothing, particularly in women. I had 2 infected organs and adhesions and nothing showed up in labs or blood work. If you know you're sick you need to be sure to get the help you need.

Now 15 days after the surgery I am feeling amazing. I don't think I even realized how bad it got (even though I knew it was bad). This slowly got worse until it was unbearble. Thankfully my general practitioner sent me to a surgeon or I would still be sick and in pain, or worse.

Jan 03, 2013
Thanks to both Nicole and Dollee
by: Dr Edema

Thanks to both Nicole and Dollee for your very informative updates and shared experience.

Dr Edema

Jan 03, 2013
Abdominal Pain in Women
by: Dollee

I'm a woman in my fifties and have had my share of abdominal pain. I've noticed that, frequently, Doctors don't pay attention to a woman with abdominal pain and consider her to be a nuisance. Recently,after difficulty getting an appointment, I went to see my PCP of 15 years after a bout of diarrhea and severe pain in the left abdoman. I also had some nausea and vomited once. The doctor poked my side one time and said I was constipated. He prescribed a high fiber diet and Miralax. That was on a Tuesday and I had already been experiencing this for two weeks. By Saturday, I was in the ER with diverticulitis and a severe infection. I changed PCPs after this incident because it's not the first time this doctor waived away female abdominal or back pain. One time, he sent me to physical therapy for back pain but didn't take an x-ray or do any tests. It turned out to be kidney stones! If you are a female with abdominal pain, don't just ignore it. Keep asking questions and go to a different doctor or the ER if you have to.

Dec 30, 2012
Newest Update, Cause Found
by: Nicole

Just another update about how I am doing and this time I seem to have answers. I had my appendix and gallbladder removed 9 days ago. When the surgeon got in there he found some adhesions binding my large intestine to my abdominal wall. He said that he can't be 100% sure that the adhesions caused the pain, but so far I have been feeling really great. I don't have the pathology back for the appendix or gallbladder yet so it could be that as well, but for now I don't care which of the 3 caused the problems. What's important to me is that I feel better. Thanks for the help and if anyone else is looking for answers I hope this helps you. I had never had surgery in this area before and there's no reason known for the adhesions. They can't be seen on a scan so no wonder I kept coming up with no answers!If you are having similar problems it might not hurt to ask about them.

Dec 06, 2012
by: Nicole

So just an update of how I have been doing. After still being in constant pain for over a week I was scheduled to see a surgeon. The surgeon is going to remove my appendix and possibly my gallbladder in 2 weeks. He is thinking it is chronic appendicitis. He will look at my appendix first and if it is the obvious problem then he will leave my gallbladder alone. If he still has doubts he will also remove the gallbladder. He said this is so that if after the appendectomy I didn't get better he would likely take the gallbladder next. This way I have one surgery instead of two. I am hoping the appendectomy works. I have still been in a lot of pain. I have gone back to work only doing half days. I come home in pain, often times vomit and then I sleep for several hours. This is after only working 3-4 hours. I have some pain pills but I try to only take 1 a day. They make my head fuzzy.
How long can chronic appendicitis be present? Months? Weeks? Years? It seems like this really horrible episode has been happening on and off for 3 months but I was diagnosed with IBS years ago. Is it possible that this was the culprit all along?

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