Mild left upper abdominal pain for approximately 9-10 months

by Robert Lloyd
(Cazenovia, NY)

I just turned 54. Have been feeling discomfort upper left abdomen just under/at rib cage for the better part of a year. Started as a feeling of just a mild "cramp". Other symptoms were SLIGHT fullness at times, VERY significant gas and flatulence. Appetite always good. No weight loss or gain. No association with eating or not eating. Wax and wane over that time. Just happened to have a routine (first) colonoscopy less than a year prior with not even a polyp- so not repeated. Testing: Upper GI scope unremarkable. Barium enema unremarkable. Basic blood work WNL- I don't believe liver function evaluated.Stool normal. urinalysis normal. CT scan revealed slightly enlarged abdominal lymph nodes- not even deemed pathologic or warranting follow-up. No other CT findings. Follow-up CT scan approx. 3 months later due to continued symptoms and my insistence yielded same findings. No significant discomfort with palpation anywhere.

the past two months or so have seen a bit of an exacerbation of symptoms. Seems almost as though the lateral aspect of my last left rib hurts as well. The past 3-4 days I have been constipated even though I have been taking Miralax for almost two weeks now (trying to see if would help Sx- wasn't constipated then, but now I am!)

Health history significant for Pyloric stenosis shortly after birth and ICD implanted approximately 10-11 years ago due to electrical conduction problems which is now complete heart block- fully dependent on pacing. Only med is Xanax 0.5 mg prn anxiety. Family history of kidney stones- my only brother and father. My brother died of liver cancer at age 54 December 2008. I do also experience various joint pain on and off- shoulders, elbows, and lower back mainly. Not the knees and never any noticeable swelling. I do make an effort to drink water. Not the 90 zillion quarts recommended daily, but more than the people around me. Urine is at least reasonably light.

Thank you.

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Dear Robert Lloyd,

Thank you for your query on the symptoms of discomfort in your upper left abdomen just under the rib cage for the better part of a year.

I can see that you have been extensively investigated for common causes of upper left abdominal pain, with all results coming back more or less normal, which is very good.

The symptoms you've described, with feelings of bloating, fullness, very significant gas and flatulence accompanying this mild upper left abdominal pain without any association with food, suggests that you may be suffering with chronic trapped wind. The xanax tabs you take could be a precipitant of this.

Functional dyspepsia is another "differential".

With the sad story of your brother dying from liver cancer, I am sure this passes through your mind often, especially now that you just turned 54 like he was before his death.

What you can do is to continue to get yourself check out from time to time. I do not think there is something very serious going on. Hopefully, in the coming weeks or months, these symptoms should get better. Did your doctor offer the option of cbt to help with your anxiety, to see if you could gradually get off the xanax?

I will say do a 6 monthly to yearly review and hopefully all will remain well.

For your constipation, I think you could get something stronger than miralax from your doctor.

Thanks again for visiting us here at abdopain.com and I hope your symptoms settles soonest.

Best Wishes.

Dr Edema.