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Having intense stomach pain. No other symptoms. Due to appendix?

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General Surgeon
Practicing since : 2008
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I\'ve got strange symptoms and I would love some advice. Woke up two weeks ago (Feb 4) with intense stomach pain. The worst I\'ve ever felt. Constant pain. It hurt more to lie down or sit so I was mostly pacing around the house. Pee and poo both normal. Mostly central / lower stomach - maybe slightly more pain on the right side but only a small difference. Some pain when I tried the \'rebound test\' of poking at the appendix. Didn\'t seem to be enough pain to suggest burst appendix. No fever. Vomited once during the pain. After about 9 hours the pain went away quite suddenly and then I was left with just some muscle soreness feeling like I had been punched in the stomach for about a day.
Then nothing for two weeks and then the exact same thing repeats itself last night. It didn\'t last quite as long - woke at 1am with terrible pain and around 6am the pain went away suddenly. Only a hot shower or hot both would help dull the pain for a few minutes. Vomited once.
Posted Tue, 12 Mar 2013 in Abdominal Pain
Answered by Dr. Grzegorz Stanko 13 minutes later

Thank you for the query.

Usually such suddenly appearing and disappearing pain can appear due to kidney stones, intestine intussusception or inguinal hernia. Partial bowels obstruction due to inflammatory bowels diseases or adhesions should be also considered.
Kidney stones usually give back pain radiating to the lower abdomen or even groin. Frequent urinating or burning while urinating appears.
Intestine intussusception can give such pain only which can be present in every abdominal area. It appears and disappears suddenly and does not give any symptoms in between the pains. Sometimes after such episode, raspberry like mucus appears in the stool. Vomiting is very characteristic.
Inguinal hernia pain is localized more in the groin area and the bruise in this area can be present.
I suggest you to have some tests next time when the symptoms will appear. Abdominal X-ray, ultrasound, full blood work, liver tests, amylase, urine analysis should be done.

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Having intense stomach pain. No other symptoms. Due to appendix? 24 minutes later
Thanks for the advice. I will get an ultrasound and blood-work done in the morning and hopefully that offers some insight. There has been no back pain or discomfort urinating (normal frequency). No signs of mucus in the stool.

I'm in Indonesia right now so the more clear I can be with what tests I request the better. To start with - ultrasound, blood work, urine analysis, liver test?

Answered by Dr. Grzegorz Stanko 8 minutes later

You should start with the ultrasound, blood work and urine analysis. The point is to do the ultrasound when the pain is present. Otherwise it can be negative. If the pain will be present, abdominal X-ray should be performed as well (it will rule out bowels obstruction).
Liver tests, amylase can be done if no findings in previous tests.

Hope this will help.
Above answer was peer-reviewed by
Follow-up: Having intense stomach pain. No other symptoms. Due to appendix? 2 days later
Hi Doc,
Thanks again for the help. Blood work and urine analysis both came back totally clean (attached). The doctor here suggested ultrasound and x-rays as the next steps but wasn't able to do either while I was there so now I've given it another day and am still feeling pretty good (slight soreness in the stomach that still feels like just recovering from the intense contraction or whatever the pain was). Should I wait to see if the pain comes back and then do an ultrasound then? Is it likely to show much when the pain isn't there?
I looked really closely at my first two bowel movements after the last episode of pain and there was definitely a little bit of red to them - not blood red or intense by any means but slightly more red than normal.
The other info I thought might be relevant is that I had done a the Bali-Canada trip before about 24-48 hours before each session (three flights, total travel time around 30 hours, total flight time of about 20 hours).
Also before the second episode I had done pretty intense exercises during the day which included a lot of sit ups. Not sure if this helped aggravate or cause anything. There hadn't been anything particularly physical prior to the first incident.
Thanks again for all your help. Any ideas would be much appreciated.
Answered by Dr. Grzegorz Stanko 13 hours later

It is better to have abdominal ultrasound and abdominal X-ray performed when the pain is present as this tests can be completely negative between the pain episodes. So if you do feel better, you should wait with this tests for the pain.
Your red stool color can be due to intestine intussusception as this is one of its symptom (raspberry like color). However this is only a theory and should be verified with mentioned tests.
Your Bali trip could cause intestine bacterial infection however diarrhea is very characteristic for it.
Intense exercises can always cause hernia occurrence (inguinal, abdominal). If so, you should have a lump in the area where the pain is located. The pain should also aggravate while coughing.

Hope this will help.
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