WOMENS-HEALTH Messages for October, 1999: Re: diagnostic laparascopy for abdominal adhesions?

Re: diagnostic laparascopy for abdominal adhesions?

From: arti (anonymous@obgyn.net)
Tue, 12 Oct 1999 20:15:12 -0500 (CDT)

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Reply: Harvey S. Marchbein, M.D.: "Re: diagnostic laparascopy for abdominal adhesions?"

At Sun, 10 Oct 1999, Harvey S. Marchbein, M.D. wrote: >
>At Fri, 8 Oct 1999, arti wrote:
>>
>>My mother is a 56-year old Asian woman. She had a
>>total abdominal hysterectomy in India about 30 years ago.
>>In 1985, she had a pelvic laparatomy with lysis of adhesions
>>in North Carolina. The records from that procedure show
>>that there was evidence of reperitonealization using the
>>sigmoid colon from the previous hysterectomy done in India.
>>There were some dense adhesions which were divided and a
>>small ovarian cyst was cauterized.
>>
>>She started having severe chronic abdominal pain about 9 years ago. She
>>is considering laparoscopy because
>>all her tests (trans-vaginal ultrasound, Upper GI, Middle GI, Barium
>>enema, CT scan) have tested negative. She couldn't have a colonoscopy
>>because of too much pain
>>on insertion. Her gastroenterologist has also asked her
>>to take a mesentin angiogram.
>>
>>Her questions are:
>>
>>1. What is a mesentin angiogram?
>
>?Mesenteric - looking for abdominal abnormalities - possibly mesenteric
>adenitis? abdominal pain from inflammed lymph nodes.
>

What is mesenteric adenitis? Her GI doctor wants to rule out the possibility of low blood supply to the intestines before scheduling the laparoscopy. Would a mesenteric angiogram help do this? Could this be diagnosed during the laparoscopy in addition to adhesions - or should she have the angiogram before the laparascopy?

>>2. Has anybody used any alternative approaches for pain
>>management and alleviation and has it been useful?
>>
>>She has a lot of facial pain at the time of abdominal
>>pain and continuous strong tinnitus which increases at the
>>time of abdominal pain. Abdominal pain increases 10-15
>>minutes after eating, and in the middle of the night or
>>early morning. Pain is more after eating. She also has
>>a heavy feeling of fullness after eating. She is also
>>frequently constipated.
>>
>>Her main concern is to choose between alternative care
>>and surgery at this time.
>>
>>Any other words of advice are welcome.
>
>I wish you and your mother well on this difficult situation.

Thank you for your good wishes. Further description of her symptoms follows in case you have any further words of advice/knowledge to impart:

Abdominal pain is in entire region of the ascending colon (right side of abdomen) and it shifts from right side of the belly button to the top of the vagina. When it occurs near the belly button, she also feels it at the corresponding position in her back. Near the belly button she feels it exactly at the spot where there was a deep hole (deeper than a wound) after the TAH in India 30 years ago (width 1 finger, and very deep - a roll of bandage was inserted in the hole, there was infection, and they would constantly change the dressing).

She is leaning toward a laparascopy at this point. She is going to talk to the surgeon about alternatives to the belly button area for making the incision due to the old hole near the belly button. She feels they may be able to find something at that site as it feels like that is where the pain begins.

>
>--
>Harvey S. Marchbein, M.D. FACOG, FACS
>Great Neck, New York
>
>**Note: Opinions expressed here are for educational purposes only
>and, as such, do not constitute a physician-patient relationship.
>This information is not intended to supplant the need for you to
>consult with your physician prior to choosing therapeutic options
>and/or interventions.
>
>**Private emails cannot be entertained due to time constraints,
>consequently no private emails will receive a response.
>
>**Thank you for your understanding ;-)
>

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