Re: Abdominal pain and umbilical secretion
From: Samir Saidi (sam@saidi.prestel.co.uk)
Wed Oct 1 18:04:15 1997
How about a Barium follow-through and/or umbilical sinogram (inject contrast
into the umbilical fistula) as a starting point?
It would not be unreasonable for her abdominal pain and bloating to be an
intermittent-type small bowel obstruction in view of her history, but may
simply have been related to coincidental urinary pathology (UTI or stone)
Sam Saidi,
O&G trainee,
London
Ricardo Savaris wrote:
> Dear neters,
>
> I just had a consult with a patient who came to me complaining of abdominal
> pain, I believe that this is not my field, but here is the case
>
> Female, 23 years old complaining of abdominal pain starting from the flanks
> to the umbilical region last Monday (29/9/97). She went to ER, presenting
> bloating, no fever, normal blood pressure, tenderness on Left Hipogastric
> region and para umbilical region, no rebound tenderness. They asked Blood
> count e urine analisys, the hemogram was normal, urine with 5 leukocytes, 7
> epithelial cels, 4 blood cells (per field).
> She stayed in observation for 5 hours on a drip with Hioscine, two hours
> later she was discharge with the diagnostic of urinary infection, receiving
> OFLOXACIN (a quinolone) and non steroid anti inflamatory drugs and
> paracetamol 750.
>
> She came to me today saying that the pain is not so intense as Monday. The
> pain is relief with Paracetal 750 mg.
>
> On my office I could complement the story.
> Ths pain has been with her for many years, it is very intense, last time
> started at the same time when she started a new diet and acupunture for
> weight loss (coincidence?)
> She had a volvus when she was 4 month old, the scar is on the right
> hypogastrc region. the umbilicus drains a yellowish secretion, staining her
> clothes, she has this also for many years (she cannot precise how long).
> Last gyn exam showed HPV and vaginal discharge with gardnerella vaginalis.
>
> No further important things on medical history
>
> On my physical exam:
>
> Enlarged mass 1 cm below the left costal edge, painfull on compression,
> without rebound tenderness, there is another painfull point also near the
> navel, on the left side of the umbilical region, abdominal distension,
> bowel movements are normal,
>
> Vaginal exam normal, without pain, no delayed period (LMP on 18/9/97).
> Presence of clue cells.
>
> I decided to ask for an abdominal US, suspend the non steroidal anti
> inflamatory drugs, just keep the paracetamol.
>
> Any ideas?
>
> Thanks
>
> Ricardo Savaris, M.D., MSc, TEGO
> Porto Alegre, Brazil
> savaris@orion.ufrgs.br
