Right sided lower abdominal pain

by NAVEEN
(INDIA)

I have been suffering with right sided, lower abdominal pain for past two years.

Its mild pain, recurrent and almost the same for 2.4 years.

Apart from this I can not take a proper diet and feel uneasiness every time.

I have had so many tests like sonography, CT-scan, barium X-ray, Manteaux test, CT enteroclysis and colonoscopy.

Almost all these were negative apart from some thickening of the small bowel and a small sticture found on the CT enterosis test.

I was clinically advised and treated for the tuberculosis for six month till June 2009.

Now I still have similar problems and my pain is increasing a bit. Again my doctor advised to go for all the diagnostic tests again including colonoscopy for the third time in last 14 months .

Can you please advice me how to get the treatment and proper advice for early treatment.

Thanks
Naveen

India

Right sided lower abdominal pain

Right sided lower abdominal pain has many causes, but it appears as if yours has been fairly thoroughly investigated Naveen. The fact that you have been found to have some small bowel thickening and stricturing would suggest two likely diagnoses. The first is a condition called ileocaecal tuberculosis (TB) which you have been treated for without much benefit and the second is small bowel Crohns disease.

Whilst you have been treated for TB, this doesnt exclude it as a possible diagnosis just because you havent responded. You may have a resistant form of TB and you could discuss this with your doctors including the possibility of trying alternative TB treatments. However, if this is Crohn?s disease then you are less likely to get a response to the antibiotics used for TB, although the antibiotic Clarithromycin may produce some response.

You might like to discuss with your doctors about having empirical treatment for Crohns disease as the investigations to date do point to this as a possible diagnosis. Some of the treatments such as Steroids and immunosuppressants would need to be used with caution as they could make the situation worse if this turns out to be TB. Careful monitoring by your doctor would be necessary. You might also like to consider a drug called Mesalazine or Mesalamine (in the UK marketed as Pentasa) which might help and shouldnt have an effect on TB.

However, to get a definite diagnosis, the best investigation now would be a laparoscopy (keyhole surgery) to actually visualise the area and take biopsies or have laparoscopic surgery. An alternative to this would be open surgery, although risks and complications are more likely plus the recovery is likely to be longer.

Sometimes we use capsular endoscopy to visualise the small bowel, although strictures would be a relative contraindication to this as there would be a risk of obstructing your bowel.

Surgery may be required to remove the affected segment of small bowel if all else fails and this will also give you a definite diagnosis.

There are other causes of small bowel thickening and stricturing including Lymphomas, Carcinoid tumours and other rarer small intestinal tumours. Celiac (Coeliac) disease, other infections e.g. Yersinia and rarely systemic conditions such as Amyloidosis can also present in this way. I dont think you have IBS in view of your investigation findings to date.