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Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease

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Gastroenterologist
Practicing since : 2000
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Hello,

I'd like to discuss about my frequent abdomen ache which is of very severe nature, the ache is at the central region and also on the sides. Along with ache, I feel, as it is very hard and feel a lot of gas in it, I get constipated like 2 days before the ache happens, and that is a signal for me that I'd get a bad ache soon. This has been happening for the past 1 yr and have been repeated over 5 times. The ache subsides after few hrs of medication.

I take:

Metrogyl
Oflox-OZ/TZ

for around 5 days (twice daily)

I have consulted a local physician and he advised me an ultrasound of the whole abdomen, the last USG was around a month back which was completely normal, the latest was today afternoon when I had severe ache, the USG findings reveals, free fluid in the interbowel region.

I have a history of Hirscprung's which was done 21 yrs back in 3 stages, can you advise me something?
Posted Tue, 8 May 2012 in Digestion and Bowels
 
 
Answered by Dr. Poorna Chandra K.S 7 hours later
Hello XXXXXXX

Thanks for posting your query.

Constipation, abdominal pain followed by abdominal tightness and relieved after sometime is suggestive of Subacute Intestinal Obstruction.

With a history of being operated earlier the first possibility is an Intestinal adhesion. Adhesions can become symptomatic many years after the primary surgery.

In veiw of Hirschprung's disease, a motility disorder of the intestines also have to be considered.

The disorder may become symptomatic with hurried meal, certain type of foods and changes in serum electrolytes.

An USG scan of the abdomen may not be an ideal investigation to look at this as it is a poor modality to evaluate air filled hollow organs. I would suggest a Contrast enhanced computerised tomography (CT) of the abdomen with a CT enteroclysis. The yeild of this test will be maximum if done during the symptomatic period.

You can continue taking the medications as and when required.

You do require a thorough examination by a Gastroenterologist and the underlying pathology should be diagnosed. Do consider this option.

Wishing you an early recovery.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 24 days later
Dear Doctor,

Thanks for your response.

I have got a CT Enteroclysis done and below are the findings:

Focal mild circumferential thickening of wall of jejunum is seen with mild dilation of proximal jenunal segment. Mild thicknened wall of rectosigmoid is seen with few small mesenteric lymph nodes.

Doctors here mentioned about chances of TB, Cancer or a possible surgery may required, can you please help us in taking the right approach and what does the above finding correlate?

Regards
 
 
Answered by Dr. Poorna Chandra K.S 48 hours later
Hi XXXXXXX

Thanks again,

The CT findings are non specific and hence needs further investigations in the form of biopsy and histopathological examination to derive anything concrete.

The possibility of cancer is less likely and the findings are usually seen in infiltrative or infective disease.

I encourage you to discuss about biopsy with your gastroenterologist.

I thanks you once again for writing your query.

Hope this helps you.

Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 11 hours later
Dear Dr Poomachandra,

Many thanks for your response.

I was/am bit hesitant in getting the biopsy done because of the fear of pain, the doctors mentioned that they will first do a Colonoscopy and if through that they're able to conduct a biopsy, good, else they'd have to do Enteroscopy.

Currently, I have been given Ceftum - twice a day and Tiniba 500 twice for 10 days, just to make sure if any infection is present in the body, it is removed.

The docks here have a very string inclination towards Intestinal TB because of the following reasons:

1) 13 Kg weight loss in around six months.
2) Weakness
3) Sub-Acute Intestinal Obstruction

Do you think it can be intestinal TB? Is there no other way other than biopsy which can rule out the infection? My ESR is 02 which was conducted yesterday, the other test results are pending, Quantiferon, IgG, IgM, IgE - at the same time the doctors mentioned that there's a high possibility that all the above tests come negative and still there could be TB.

What do you suggest sir, if at all biopsy is required, how should we conduct it, Enteroscopy, colonoscopy or both?

Many thanks for letting me know.

Regards


 
 
Answered by Dr. Poorna Chandra K.S 15 hours later
Hi XXXXXXX

Eventhough TB commonly involves the ileo cecal area, it can have a varied affection and in a place like India, it is the first diagnosis. Establishing diagnosis in TB of areas other than the lung is difficult because of difficulty of accessability, the low number of bacilli and difficulty in obtaining a full thickness biopsy.

Other infiltrative diseases like eosinophilic enterocolitis may also be considered. The primarily affected regions are the jejunum and rectosigmoid area on the CT. As the rectosigmoid area is easier to access the first approach has to be colonoscopy and biopsy. It also provides access to ileocecal area.

Hope I have answered your query adequately.

Thanks again and Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 2 days later
Hello Dr XXXXXXX

Thanks for getting back to me.

I have a blood test report of TB Gold and the tests are positive as below:

Gamma Interferon, Antigen Tube: 1.89 IU/ml
Gamma Interferon, Nil tube: 1.36 IU/mL

I have been told that this test is much better than the Mantoux text and its reliability is a lot more, does it mean that I have TB?

Would really appreciate your help and suggestion in the next course of action.

Regards
 
 
Answered by Dr. Poorna Chandra K.S 48 hours later
Hi again XXXXXXX

Thanks for raising the concern.

Interferon gold like mantoux is a supporting evidence and suggests an active inflammatory response to TB.

It is better that you get the biopsy and be rest assured that biopsy perse is painless. It is only the air insuffulation during colonoscopy that causes some discomfort.

Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 96 days later
Dear Sir,

First of all allow me wish you and your family a very Happy New Year.

I have been getting treated by a local well known Gastroenterologist in Delhi, a Barium Follow Through was conducted to see an obstruction, but it was normal, they did find some adhesions but that are because of Hirschprung's disease history.

I was told to take following medicines for 1 month:

Velgut D: Lyophillized Saccharomyces : 282.5mg + Lactic Acid Bacillus: 150 million spores

Duphalac: 15ml - 25ml

Well, the problem which I am having at the moment is that I'm not able to pass stools properly and not because I have hard stools but the stools are very sticky, even if I take 25ml Duphalac in the night, I'll not be able to pass anything in the morning, I again have to take it in the morning and after 2-3 hrs I pass stool, and then in a watery form.

I have been really frustrated with this problem and just can't live with it.

I have done an extensive research on it on the internet and have learnt that the problem is because of the sticky stools.

I have noticed one very interesting thing happening with me:

If I take Ceftum (Cefuroxime axetil) 500 mg - 1 tablet per day for 2-3 days, my sticky stools are completely gone and I'm even able to pass stool without taking Duphalac. This is a great relief for me but at the same time I do understand and am fully aware of the side-effects of Ceftum.

I would really really appreciate if you could help me out on how to cure this problem.

I really appreciate your help and looking forward to hear from you in anticipation.

Regards
 
 
Answered by Dr. Poorna Chandra K.S 2 hours later
Hi and thanks for the followup information
Sticky stools are usually due to fat malabsorption and this can be secondary to -
1) Pancreatic disorder
2) Ileal disease leading to malabsorption
3) Bile acid deconjugation leading to fat maldigestion. This is also caused by bacterial overgrowth which may be secondary to poor or an inco-ordinated intestinal motility. In your case it is secondary to adhesions. The response to antibiotics also supports this cause of sticky stools
Treatment would involve cyclical antibiotic therapy or breaking down the adhesions. Regarding the antibiotic I would suggest Rifaximin as it is not absorbed and hence has a lesser side effect
Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 2 days later
Dear Sir,

In this situation what should I do, doctors here say that adhesions cannot be broken, it would lead to more complexity if operated.

I'm able really very disturbed, your help would be greatly appreciated. Is there a number on which I can call you and discuss, I'm not sure if this is possible?

Regards


 
 
Answered by Dr. Poorna Chandra K.S 12 hours later
Hi and thanks for the feedback.

It's true that sometimes surgeries done to relieve an adhesion lead to more adhesions. If your surgeon feels so I think you need to go along with that.

In such cases we advice cyclical antibiotic therapy say one course every month or two so as to keep the bacterial overgrowth in check. The preferred antibiotic is rifaximin for the reasons explained earlier.

I am sorry, as per the policy I cannot give you my personal contact number; however you can write to me with your details at YYYY@YYYY referring my name, I shall reply you as soon as possible.

Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Abdomen ache, constipation, taken Metrogyl, Oflox, normal USG, Hirschsprung's disease 2 days later
Sir,

Thanks for your quick revert.

My contact details are:


I am really grateful for your support.

Regards
 
 
Answered by Dr. Poorna Chandra K.S 8 hours later
Hi,

Thanks for the information.

I have mailed you on your id.

Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
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