Pain in the lower right abdomen

[maxme]

One night, not so long ago, I went to bed feeling somewhat uneasy. The reason was I've been travelling for 20 hours and hardly got any sleep during that time, another problem was that I hadn't been able to go to the john that time either.

As soon as I hit the sack in our hotel room, I got intense pain in the lower right abdomen and it was like a cramp that lasted for almost 3 hours. It started to subside after that but I couldn't get any sleep that night.

Now it has happened before about 3-4 months ago, so my question is, is there anyone who has experienced this and know what it is?

[FBN]

Impossible, and even irresponsible to try and venture a diagnosis with info given on a forum such as this.

Appendix, intermittent bowel obstruction due to various reasons and even hernia may all cause these symptoms. It seems to be recurring and needs to be investigated. Please consult a reputable surgeon.

[jrtmedic]

Agreed ----medical advise should be sought.

Here is a list of possible causes of lower right sided abdominal pain !

Differential diagnosis

Right iliac fossa (RIF) pain may be acute or chronic/subacute.

Causes of acute RIF pain

Gastrointestinal causes:

Appendicitis: if the appendix is retrocaecal there may be no guarding. In pregnancy the gravid uterus will push up the appendix and hence the site of tenderness. Carcinoid tumours may occasionally present as appendicitis.

Crohn's disease: the most common site for Crohn's disease is the terminal ileum and here it may mimic appendicitis.

Mesenteric adenitis: this primarily affects children. It is caused by a viral or bacterial infection. Adenoviruses, Epstein Barr virus, beta-haemolytic streptococcus, Staphylococcus spp., Escherichia coli, Streptococcus viridans and Yersinia spp. have all been implicated as well as Mycobacterium tuberculosis and Giardia lamblia[2] It may occur in adults but is mostly in those aged under 15. Patients may have a high temperature and there may also be other evidence of a viral infection, eg enlarged submandibular lymph glands and leukocytosis. If laparotomy is performed, enlarged mesenteric lymph nodes will be apparent.

Diverticulitis: diverticular disease affects the distal colon more than the proximal colon. However, diverticula and inflammation and/or abscesses may occur in the ascending colon. Perforation may also occur.

Meckel's diverticulitis: a Meckel's diverticulum is a congenital anomaly that is present in about 2% of the population. Meckel's diverticulitis can mimic appendicitis.

Perforated peptic ulcer: this usually produces upper quadrant pain but pain may be lower.

Right inguinal/femoral hernia: an incarcerated right inguinal or femoral hernia may present as RIF pain. There will be tenderness and an irreducible swelling over the hernial orifice, and symptoms and signs of bowel obstruction. Cough impulse is lost if hernia is incarcerated. Requires urgent surgical referral.

Malignancy: carcinoma of caecum or ascending colon can present with bowel perforation.

Gynaecological causes

Pelvic inflammatory disease (PID)/salpingitis/pelvic abscess: typically, vaginal discharge is present. More common if there are multiple sexual partners, a history of PID and if an intrauterine device is in situ.

Ectopic pregnancy in the right Fallopian tube: pain rather than vaginal bleeding is the prominent feature. If in doubt, admit. When rupture occurs bleeding is profuse and 2 or 3 litres of blood can be lost in a short space of time, with consequent hypovolaemic shock.

Ovarian torsion: this usually happens when an ovary is enlarged by a cyst. Diagnosis can be difficult. There may be adnexal tenderness. Ultrasound may show the abnormal ovary.

Threatened or complete abortion: if a pregnancy test is positive and there is a history of bleeding, always refer for an ultrasound scan to exclude an abortion. If there is associated pain, an ectopic pregnancy needs excluding by immediate referral to secondary care.

Mittelschmerz: this is a sudden onset of mid-cycle pain.

Fibroid degeneration.

Pelvic tumour.

Urological causes

Ureteric colic: this can cause pain that may be intermittent and 'shooting'. A stone may cause microscopic haematuria. 70% are visible on plain X-ray. Ultrasound is a good diagnostic technique.

Urinary tract infection (UTI): urinary frequency, dysuria, haematuria, urgency and smelly urine may raise this as a differential diagnosis.

Testicular torsion or epididymo-orchitis: may produce pain that is referred to the lower abdomen on that side. The testis will be very tender.

Other causes

Infections: tuberculosis, typhoid and Yersinia spp. can all produce ulceration of the ileum that can perforate. Herpes zoster infection in the T10, 11, or 12 dermatome can produce RIF pain. There is usually a characteristic rash. The skin is usually tender rather than a deeper pain.

Abdominal aortic aneurysm (AAA): this can present with atypical symptoms resembling renal colic or diverticular disease rather than the classic back or flank pain. Do not forget this differential diagnosis. Look for a pulsatile abdominal mass. Approximately 30% of patients with a ruptured AAA are misdiagnosed initially.[3]

Situs inversus: here the differential diagnosis for RIF pain is as that for left iliac fossa (LIF) pain (refer to separate article Left Iliac Fossa Pain). Only half of those with dextrocardia have total situs inversus.

Causes of chronic RIF pain

Gastrointestinal causes:

Irritable bowel syndrome: should be a diagnosis of exclusion. The bowel may be loaded and tender.

Carcinoma of the caecum or ascending colon: there is usually an associated change in bowel habit, weight loss and rectal bleeding.

Crohn's disease and ulcerative colitis: with inflammatory bowel disease, there will probably be associated diarrhoea with blood and mucus.

Gynaecological causes:

Ovarian/pelvic tumour.

Endometriosis.

Other causes:

Right hip pathology: may cause referred pain in the RIF.

Familial Mediterranean fever: this may cause recurrent abdominal pain, mostly in the first decade of life.

[AnotherOneAmerican]

Intense pain, usually starting in the early hours of the morning.

Lower right, appendicitis

Higher right (just under first rib), gallbladder

A history of acid indigestion would indicate gallbladder.

Just two of the most common possibilities.

Edited July 24, 2013 by AnotherOneAmerican

[Richie23]

Just go see a doctor, it's not difficult.

[AnotherOneAmerican]

Just go see a doctor, it's not difficult.

To be fair, if no pain at the moment, very hard for a doctor to diagnose.

He needs to be in a hospital while it is hurting so they can view which area is inflamed/infected.

[FBN]

Just go see a doctor, it's not difficult.

To be fair, if no pain at the moment, very hard for a doctor to diagnose.

He needs to be in a hospital while it is hurting so they can view which area is inflamed/infected.

Still worth a visit.

A simple abdominal ultrasound, which is non-invasive, and a thorough physical exam which should include a detailed history, may very well bring to light a condition that may result in a medical emergency down the line if not managed proactively.

[AnotherOneAmerican]

Just go see a doctor, it's not difficult.

To be fair, if no pain at the moment, very hard for a doctor to diagnose.

He needs to be in a hospital while it is hurting so they can view which area is inflamed/infected.

Still worth a visit.

A simple abdominal ultrasound, which is non-invasive, and a thorough physical exam which should include a detailed history, may very well bring to light a condition that may result in a medical emergency down the line if not managed proactively.

Or it could just produce a lot of expensive tests which are inconclusive.

The doctors over here normally have to be slapped in the face by symptoms before they decide anything.

Edited July 24, 2013 by AnotherOneAmerican

[jrtmedic]

"Or it could just produce a lot of expensive tests which are inconclusive.
The doctors over here normally have to be slapped in the face by symptoms before they decide anything."

​If you are talking about the American health care system one must, absolutely, agree !

[AnotherOneAmerican]

"Or it could just produce a lot of expensive tests which are inconclusive.

The doctors over here normally have to be slapped in the face by symptoms before they decide anything."

​If you are talking about the American health care system one must, absolutely, agree !

American system is worse, if you have insurance they will operate!

[jrtmedic]

AnotherOneAmerican

Thanks for taking my "slap" in the humorous spirit intended !

Edited July 24, 2013 by jrtmedic

[FBN]

The correct advice here remains to have it checked out; irrespective of whether it "may be" inconclusive. At least then any serious medical condition would have been excluded. The advice given assumes ethical management of the individual and can not be changed based on "possible" overcharging or inappropriate and costly tests that "may" be incurred.

Imagine this happening to the OP on the next flight at altitude; which it very well may if it is an intermittent or incomplete bowel obstruction or overnight in a country with inadequate medical services..

[Satcommlee]

A private hospital may ask you have a CT scan, which can be expensive.

I had a similar thing a few years ago, although not intermittent, turned out to be a burst appendix but the pain seemed generalized to the whole abdomen until it settled down to the right side only, which is where they suspected appendicitis.. but for me it was accompanied with a lot of vomiting and inability to keep fluids down.

[Sheryl]

An ultrasound, which is considerably less expensive than a CT, would be more usual with CT only if ultrasound findings inconclusive.

As FBN has said, it is important to get this evaluated to rule out appendicitis and other potentially serious conditions.

OP if you would like a recommendation as to doctor/hospital, pls advise your location

[maxme]

Thanks for all the comments...

@Sheryl, the mrs apparently booked both of us for health check at Bamrungrad, so I will find out on Sunday, thanks for the concern.