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What Causes Lower Abdominal Pain With Mass, Fever And Weight Loss?
Question: Hi,
For the last 3-4 weeks now I've been experiencing abdominal pain (sharp at times), nausea, loss of appetite, weight loss, slight fever (37.3-37.8) and in the last week or so I have been able to feel a "bulge" in the lower right abdomen. Been to see my family doctor who sent me for colonoscopy (clear), pelvic and abdominal ultrasound, blood and urine tests (all OK) and he thinks the next step would be laparoscopy which could take days/weeks to schedule. In the mean time, i am in pain, not eating much, losing weight, and really worried. I really want to get to the bottom of this quickly, 4 weeks with no diagnosis is not good... CT scan, MRI? How should I be proceeding? Go to the emergency at the local hospital? If it is intestinal loop is it OK to wait or do I need to go to the hospital sooner?
For the last 3-4 weeks now I've been experiencing abdominal pain (sharp at times), nausea, loss of appetite, weight loss, slight fever (37.3-37.8) and in the last week or so I have been able to feel a "bulge" in the lower right abdomen. Been to see my family doctor who sent me for colonoscopy (clear), pelvic and abdominal ultrasound, blood and urine tests (all OK) and he thinks the next step would be laparoscopy which could take days/weeks to schedule. In the mean time, i am in pain, not eating much, losing weight, and really worried. I really want to get to the bottom of this quickly, 4 weeks with no diagnosis is not good... CT scan, MRI? How should I be proceeding? Go to the emergency at the local hospital? If it is intestinal loop is it OK to wait or do I need to go to the hospital sooner?
Brief Answer:
Go to ER
Detailed Answer:
Welcome to Healthcaremagic.
Hi, I am Dr Anshul Varshney , I have read your query in detail , I understand your concern.
Lower abdominal pain with mass , fever , weight loss points towards some serious etiology. Right lower abdominal mass can be Appendicular lump, Tubercular ileitis, Local abscess.
The first step towards the management of such issue is an Ultrasound Abdomen. if there is a lump, the Ultrasonologist would be able to find it and give you a diagnosis. But you mentioned that the ultrasound was normal, so it is a possibility that you had an acute appendicitis attack at that time, which can be missed on ultrasound and later it can turn into an appendicular lump.
I would recommend strongly to go for CECT Scan of abdomen in such case which will probably rule out the etiology.
If it is an abscess or appendicular lump, you need intravenous antibiotics and surgical drainage of abscess if required. You should not wait, as a lump can also rupture. Moreover, you are febrile it means an active infection is there.
You should go to ER and let them evaluate, they will send you for an emergency ultrasound followed by CECT Abdomen. If any appendicular lump or abscess is found, they will admit you.
This is my personal opinion based on details available here. If you still have any other query, you may please ask me.
Stay Healthy.
Dr Anshul Varshney , MD
Go to ER
Detailed Answer:
Welcome to Healthcaremagic.
Hi, I am Dr Anshul Varshney , I have read your query in detail , I understand your concern.
Lower abdominal pain with mass , fever , weight loss points towards some serious etiology. Right lower abdominal mass can be Appendicular lump, Tubercular ileitis, Local abscess.
The first step towards the management of such issue is an Ultrasound Abdomen. if there is a lump, the Ultrasonologist would be able to find it and give you a diagnosis. But you mentioned that the ultrasound was normal, so it is a possibility that you had an acute appendicitis attack at that time, which can be missed on ultrasound and later it can turn into an appendicular lump.
I would recommend strongly to go for CECT Scan of abdomen in such case which will probably rule out the etiology.
If it is an abscess or appendicular lump, you need intravenous antibiotics and surgical drainage of abscess if required. You should not wait, as a lump can also rupture. Moreover, you are febrile it means an active infection is there.
You should go to ER and let them evaluate, they will send you for an emergency ultrasound followed by CECT Abdomen. If any appendicular lump or abscess is found, they will admit you.
This is my personal opinion based on details available here. If you still have any other query, you may please ask me.
Stay Healthy.
Dr Anshul Varshney , MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your advice and quick response. I'll let you know how it goes.
Brief Answer:
Get well soon .
Detailed Answer:
Hi.
I am glad you liked the reply. I hope your problem resolves soon.
You can any time reopen this discussion for any help.
If you have any further query, please ask me else close the discussion and rate it.
Stay Healthy.
Get well soon .
Detailed Answer:
Hi.
I am glad you liked the reply. I hope your problem resolves soon.
You can any time reopen this discussion for any help.
If you have any further query, please ask me else close the discussion and rate it.
Stay Healthy.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Dr Varshney,
I finally went to the ER late last night. They did new urine and blood tests and an examination of the bulge. based on the clean blood and urine results they did not order an emergency CETC Scan and told me to go back to the family doctor and get a referral to a gastroenterologist... The ER doctor we saw said she did not want to expose me to unnecessary radiation plus she would not know what to look for... 6 hours at the hospital for nothing, I still don't have a diagnosis. How should I proceed next? Urge the family doctor to requisition a CETC Scan right away? Do you guys have anybody in XXXXXXX Canada that can requisition a CETC Scan? The family doctor is sending me to a surgeon for a laparoscopy. Should we be doing both? I don't know what the wait times for either would be on a non-emergency basis (I think 15-30 days for a CT scan, maybe the same for a laparocopy.) Also, is there any point in looking at a stool sample for possible parasites?
I would appreciate your thoughts, thank you.
XXXX
I finally went to the ER late last night. They did new urine and blood tests and an examination of the bulge. based on the clean blood and urine results they did not order an emergency CETC Scan and told me to go back to the family doctor and get a referral to a gastroenterologist... The ER doctor we saw said she did not want to expose me to unnecessary radiation plus she would not know what to look for... 6 hours at the hospital for nothing, I still don't have a diagnosis. How should I proceed next? Urge the family doctor to requisition a CETC Scan right away? Do you guys have anybody in XXXXXXX Canada that can requisition a CETC Scan? The family doctor is sending me to a surgeon for a laparoscopy. Should we be doing both? I don't know what the wait times for either would be on a non-emergency basis (I think 15-30 days for a CT scan, maybe the same for a laparocopy.) Also, is there any point in looking at a stool sample for possible parasites?
I would appreciate your thoughts, thank you.
XXXX
Brief Answer:
Talk to your family Doctor.
Detailed Answer:
Hello. I am so sorry to hear that they didn't help you. I feel they must have examined you and must have felt that this is no appendicular lump.
In such scenario I would first recommend CECT followed by diagnostic laproscopy.
As far as radiation exposure is concerned then yes it is there but occasional exposures don't harm.
I am sorry I don't have any one known there. But you should go back to your GP and ask him for a CECT Abdomen. Diagnostic Surgical intervention in non emergency is only indicated if Scans can't be performed due to any reasons.
Stool test will rule out any parasite in case there is bowel obstruction or intusseception due to parasites.
I hope it helps.
Stay Healthy.
Talk to your family Doctor.
Detailed Answer:
Hello. I am so sorry to hear that they didn't help you. I feel they must have examined you and must have felt that this is no appendicular lump.
In such scenario I would first recommend CECT followed by diagnostic laproscopy.
As far as radiation exposure is concerned then yes it is there but occasional exposures don't harm.
I am sorry I don't have any one known there. But you should go back to your GP and ask him for a CECT Abdomen. Diagnostic Surgical intervention in non emergency is only indicated if Scans can't be performed due to any reasons.
Stool test will rule out any parasite in case there is bowel obstruction or intusseception due to parasites.
I hope it helps.
Stay Healthy.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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