Thanks. Interesting stuff. I didn't get to read too much but it seems closely related to some tests.

I brought her to the emergency department again late morning yesterday (Tuesday) since her pain persisted from mid-afternoon Monday into Tuesday. She was admitted to the hospital, although the admitting doctor seemed focused on possible scar tissue from a hysterectomy in May 2024. He basically said there was no surgical solution but said he'd order a consult with pain management. Uh, no, that's not the way things are going to go. The pain is too severe to live with. I'm hoping to talk to Gasto Wednesday and get more tests done.

Tuesday's tests included a urinalysis and a CT Abdomen/Pelvis. She still has a raging UTI despite finishing a prescription days ago. The CTA notes: "Slightly atypical trajectory of the sigmoid colon without evidence of acute sigmoid volvulus. The relative twisting of the mesentery of the sigmoid colon may be due to an internal adhesion and may increase the likelihood of developing a volvulus however there are no acute findings. The patient's intermittent postprandial abdominal pain may be due to a different factor however intermittent partial volvulus formation should be considered." Of course, I'm focused on "intermittent partial volvulus formation should be considered" because her pain is severe and almost constant, and additional GI tests can help clarify.

She also had a CT Angio Abodomen/Pelvis 2 weeks ago. The results include "Unchanged appearance of hazy mesenteric fat with prominent subcentimeter mesenteric lymph nodes, in keeping with sclerosing mesenteritis/mesenteric panniculitis."

I use AI a lot to try to piece things together. When I fed a lot of info from both CTs, the result included:
- The inflammation and fibrosis can cause adhesions or stiffening of the mesentery, leading to the atypical sigmoid trajectory, mesenteric swirling ("whirl" appearance), and relative twisting you had described earlier. source: clinicalradiologyonline.net

- This altered mesenteric mobility/fixation can predispose to intermittent partial twisting or kinking of the sigmoid (or other bowel loops), which aligns with the radiologist’s note about considering intermittent partial volvulus as a possible contributor to your postprandial pain. source: europepmc.org

- It is a known (though uncommon) contributor to bowel motility issues, tethering, or even rare cases of volvulus/obstruction.