Concerns About Abdominal Distension and Uterine Status
A 65-year-old woman, measuring 5 feet 1 inch and weighing 106 pounds, presents with notable abdominal distension resembling that of a 28-week pregnancy. This condition arose following her bowel resection in January 2022 and the reversal of her ileostomy in April of the same year, both necessitated by a ruptured abscess linked to diverticulitis. Since January, she has experienced discomfort in the right lower quadrant, specifically at her stoma scar site. Despite undergoing a CT scan and pelvic ultrasound in January, which yielded normal results, and extensive evaluations by her gastroenterologist, the only notable finding has been mild swelling in some colonoscopy biopsies. However, her pain has intensified and is now radiating, alongside a notable change in her bowel habits to the consistency of small animal droppings rather than hard stools. Additionally, she reports significant bloating. In early August, a repeat CT scan with both oral and IV contrast revealed heavy stool accumulation and gross distension in the left abdominal area, leading the radiologist to suggest the presence of gastroparesis. Yet, the most alarming finding from this examination indicated that her uterus was described as "surgically absent." Although she acknowledges that the uterus reduces in size post-menopause, she recalls it being present during her prior January imaging, which included measurement of the endometrial lining. Furthermore, the second CT report mentioned it in comparison to a scan from early 2025. The patient conveyed to her gastroenterology nurse practitioner (NP) that the uterus had not been surgically removed in the seven months prior. Recently, the NP communicated that the same radiologist reaffirmed his initial interpretation of the CT, declaring it surgically absent. The NP suggested that the uterus may have collapsed. Given her escalating pain, she is concerned that potential adhesions might be causing discomfort by attaching her uterus to her bowel. Is this a plausible scenario? A transvaginal ultrasound is expected to help clarify the situation, but weeks have passed without any updates. She understands that the uterus may not be visible anymore and would prefer the documentation reflect "unable to visualize uterus" instead of a surgical removal that she never underwent. She is perplexed by the radiologist’s insistence on surgical removal despite no documented history of such a procedure. For context, she has never experienced gastrointestinal issues or constipation prior to her diverticulitis diagnosis, which seemed to strike suddenly. Post-ileostomy reversal, she had no significant issues until the onset of her current right lower quadrant pain, which disrupts her daily life. Notably, she is pain-free during the mornings, with discomfort beginning in the afternoon, intensifying throughout the evening, and subsiding by late night. Despite varying degrees of pain intensity on different days, she has attempted elimination diets and other strategies, but nothing alleviates her symptoms. Loud bowel sounds are also present intermittently. Moreover, she struggles to receive timely responses through her patient portal and is contemplating the use of laxatives to alleviate the stool obstruction, concerned about the risk of dependence. Considering the ongoing challenges she faces, she seeks any advice or insights into her condition.
Answers (1)
9/6/2025, 4:20:35 AM
OpenHealth AI
It sounds like you are experiencing significant discomfort and confusion regarding your abdominal distension and the recent findings about your uterus. It's understandable to have concerns given the complexity of your medical history, especially after undergoing bowel surgery and ileostomy reversal.
Main Points
- Possible Causes for Symptoms: Your ongoing abdominal distension, pain, and changes in bowel habits may be indicative of gastrointestinal issues, potentially related to adhesions or bowel obstruction. The mention of gastroparesis could also be relevant.
- Uterus Finding: The report suggesting that your uterus is "surgically absent" is concerning, especially given your history and contrasting findings. This warrants further investigation.
- Action Steps: Focus on symptom monitoring, consider dietary adjustments carefully, and advocate for timely follow-up tests to clarify your condition.
Explanation
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Abdominal Symptoms: Your experience of distension and pain in the right lower quadrant could be related to adhesions from previous surgeries, which may cause bowel obstruction or pain. Gastroparesis (delayed gastric emptying) can lead to feelings of fullness and bloating as well, and the change to smaller bowel movements suggests possible constipation or impaction.
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Uterus Imaging Confusion: The discrepancy between the CT scans regarding the presence of your uterus needs further clarification. Your concern is valid, and it’s crucial to address this with your healthcare team. There could be technical reasons why the uterus wasn't visualized, but you deserve accurate documentation reflecting your medical history.
Next Steps
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Monitor Symptoms:
- Keep a detailed diary of your symptoms, noting pain levels, bowel movements (consistency and frequency), and any other changes in your health. This will be helpful for future consultations with your healthcare providers.
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Diet and Laxatives:
- Diet: Continue to eat a balanced diet rich in fiber and stay hydrated, which can sometimes help promote regular bowel movements. Avoid heavy or constipating foods, noting any that may worsen your symptoms.
- Laxatives: If you feel it's necessary to use laxatives for constipation, consider starting with fiber supplements (like psyllium) or osmotic laxatives (like polyethylene glycol) on a short-term basis and monitor your response closely. Avoid long-term use unless directed by a healthcare provider.
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Follow-Up on Imaging:
- Request your healthcare team to prioritize the transvaginal ultrasound to assess your uterus and clarify the findings of the previous CT scan. Express your concern about the documentation regarding your uterus.
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Pain Management:
- You may want to discuss with your healthcare provider about strategies for managing your pain effectively, especially considering it is impacting your daily activities.
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Healthcare Communication:
- If you're encountering delays in receiving updates or responses on your patient portal, consider calling your healthcare provider’s office directly. Advocate for your needs and request timely follow-up for your tests and evaluations.
Remember, you're not alone in this; it's important to keep engaging with your healthcare providers until you get the clarity and relief you deserve. Don't hesitate to reach out for further clarification on your condition or any additional concerns you may have.
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