Pain in upper left abdomen

[meteoman]

Hello. I am new to this forum. I am 38 yo and was diagnosed with Crohn's disease in 1987 at the ripe old age of 13. My disease at the time was quite aggressive and did not respond well to Prednisone. I had surgery on the ileum and cecum in 1988. Since that time I have been relatively well. However, from time to time, I do get intense pressure in my upper left abdomen - under the rib cage. It's actually pinpoint type of pressure/pain; almost as if someone is pushing into me with a semi-sharp object. I feel it demonstratively when I walk and also when I jump up and down. Also, when I push on my abdomen, I can feel the pain more toward the center of the abdomen and a little further down from the "referred pain" that actually manifests. Anyone have the same issue with a doctor's dx? I am thinking it might be a mechanical stricture (as opposed to inflammed or fibrostenotic from active Crohn's) as a result of the original surgery. Maybe adhesions or other type of scar tissue issue? On occasion, the pressure is relieved resulting in some gurgling. There is some mild, yet remarkable distention as well.

 

[David]

Hi there and welcome to the forum I'm glad you joined

Hmmmm. I'm guessing that the surgery on your ileum was actually your terminal ileum (the most distal part of your ileum) since your cecum was involved as well. That would be in your lower right quadrant, quite a ways from where your issue is now so I can't see it being directly related to the surgery though stranger things have happened.

Stricture does indeed come to mind especially since the pressure is sometimes relieved and the distention.

Have you discussed this with your GI? Have any tests been run?

 

[meteoman]

Thanks for the response!

Upon mentioning it to my Gastro; he seemed to think it may be adhesions. I recently had a colonoscopy which revealed an ileocolic anastomosis stricture approximately 95% blocked. He inflated it with a balloon. He said, however, there was no active Crohn's disease all the way into the terminal ileum (or I should say neoterminal ileum). He did mention that the dilation with the balloon will probably be a long term fix. I researched this, and for the most part, he is right. There is a ~65% chance that it will remain clear if it is not due to active Crohn's. However, the colonoscopy procedure did not fix the left side issue. When I had my original resection in 1988, the surgeon did say he left a couple of small mildly narrowed areas. I think they were even too small to do an effective strictureplasty. My thinking is that (even though it is some 25 years later) that my left side issue is a referred pain from a narrowing of one of these smaller strictures. If so, it is probably upstream from the neoterminal ileum and thus virtually impossible to fix with a dilation procedure.

 

[David]

Could be.

Were they doing strictureplasty's 25 years ago?

Have you discussed having tests such as MRE (Magnetic Resonance Enterography) or small bowel follow through or other procedures to have a look at what's going on in there, with your doctor?

I'm thinking MAYBE SIBO (Small Intestine Bacterial Overgrowth) but it doesn't really fit all that well.

 

[meteoman]

Yes, strictureplasty was a very new procedure in 1988 and I was one of the first to undergo it. My surgeon was very good and I owe my life to him.

I was thinking about trying probiotics. Never tried them before except for eating yogurt.

I have had upper GI's in the past that were clean. However, my issues are fairly recent and I haven't had an Upper GI in about 2 years. I might suggest that to him. Or maybe a CT. One thing I have noticed was the lack of availability of doctors as of recent. This will probably get worse if we become more like Canada with regard to healthcare. My Gastro can't see me until August for follow up to yesterday's colonoscopy. That's insane!

 

[David]

That's great that you had a surgeon who was able to do one of the first strictureplasty's on you. Very cool.

I don't think an upper GI would get quite as far into your intestines as you'd want.

 

[meteoman]

Sorry, you're right. I meant Upper GI with Small Bowel Follow Through. It's late.