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Dr. Andrew Rynne

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What causes severe pain around sigmoid colon?

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Dr. Soumya

OBGYN

Practicing since :2010

Answered : 2832 Questions

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Posted on Wed, 21 Oct 2015 in General Health
Question: I am post-hysteroscopy and pre-hysterectomy/oopharectomy (laparoscopic, with vaginal removal of the uterus) for stage 1 endometrial carcinoma -- next Monday. I am not diabetic, hypertensive, or overweight. I do not have a fever. I have never had previous surgery and am 75.
I have increasing pain/pressure near sigmoid colon or at the lower or mid- area of the descending colon, now daily rather than occasional, plus frequent abdominal bloating.
I have had incidental pressure in area of descending colon for years, but never on a daily basis (IBS, perhaps?) Occult blood test 11 months ago was negative, as were two previous sigmoidoscopies (over 15 years ago).
Pre-op does not include any bowel prep, and my request for possibly additional imaging (CT scan?) was regarded as unnecessary. However, because of these symptoms. I am very concerned about bowel inflammation and the risk of perforation, even though the risk is low. Is there anything I can do to mitigate this situation?
doctor
Answered by Dr. Soumya 18 minutes later
Brief Answer:
Bowel involvement

Detailed Answer:
Hi,

I understand your concerns about bowel involvement.

The bowel symptoms you have experienced is because of possible adhesions between colon and uterus which causes such pain and is difficult to identify even by CT scan.

There is no reason to worry about bowel perforation or injury as it can be tackled during laparoscopy and care can be taken not to injure it.

No additional tests are required. Be relaxed and go ahead with surgery.

Let me know if you need any more clarification.

Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Soumya 2 hours later
Thank you, esp. for the comment about difficulty of diagnosis even by CT.

I have never had any kind of surgery involving an incision, and the material I have read implies that adhesions are a side-effect of surgical intervention. Also, the location of the pain/pressure is not near the uterus, which is small, but near the left ovary. However, this pain/pressure is relieved by defecation and also is not always in the same location. Sometimes it is further left (near the intersection of sigmoid and descending colon), and sometimes it is higher, suggestion only the descending colon.
Do these facts suggest a different diagnostic theory? What about just irritable bowel syndrome? Would that be causing these minor pains and pressure?
Also, I have read two different papers showing that bowel perforation during laparoscopy is very uncommon (<0.5%), but that when it does happen, almost half of those perforations go undiagnosed until the patient then has to endure a second surgery. That is why I'm concerned about the lack of bowel prep. The nursing staff assures me it is not necessary and that I only must refrain from solid food for 12 hours.
What would happen if I undertook a supposedly safer course, and decided on a clear liquid diet for 24 hours? Would that deplete nourishment and electrolytes too much?
Or is there anything else I can do to free up the intestine without interfering with the healing process?
Again, thank you for your reply.
doctor
Answered by Dr. Soumya 26 minutes later
Brief Answer:
Adhesions leading to pain

Detailed Answer:
Hi,

It is not necessary to have undergone surgery to have adhesions.

Adhesions can also form due to even infection sometime in your life. These different location pain I relation to different portion of bowel indicate adhesion to different areas of bowel to uterus. Hence pain is not located to uterus region.

You can have liquids for 24 hours which will not have any adverse effects or nutrition lack. It is safe to do so. There is nothing to worry about. Be on liquid for 24 hours. Its good decision.

Let me know if you need anymore help.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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