Abdominal abscess that doesn't show on CT scan

Several years ago I went to a very good visceral massage therapist and also a physical therapist. Both of them immediately saw and commented on my swollen left buttock as well as a calcified pathway from my left groin that looked like it was pulled down into my thigh. This was before I even had a chance to say anything to them about my symptoms so there is in fact external evidence of it. But none of the Drs I went to were able to see it. All they saw was that the area was red and they swabbed it but the lab test didn't identify anything.

After so many years of symptoms and evaluations that haven’t provided an explanation, I can understand why you’re concerned about whether this upcoming appointment will be different.

One thing that stood out to me is that you have several very specific observations you can give the gastroenterologist — particularly having passed gas through your bladder, the drainage and odor you describe, the persistent swelling on one side, and what the massage therapist and physical therapist observed. Rather than having to convince the doctor that this is an abscess or fistula, I wonder if you might ask, “What could explain these symptoms, and what would be the appropriate way to investigate them if a routine CT hasn’t shown the cause?”

It might also be worth asking what findings would lead the doctor to involve another specialty, such as colorectal surgery or urology.

Since you mentioned recently feeling generally unwell as the swelling has worsened, I wouldn’t wait for the GI appointment if you develop fever, severe or rapidly worsening pain or swelling, vomiting, confusion, or otherwise become acutely ill.

You’ve been dealing with this for a very long time. For your upcoming appointment, do you have records from the hysterectomy or exploratory surgery that documented the adhesions, or any records describing the bladder symptoms or the swelling?

I wish that I had gotten the records for my exploratory surgery which was back in 1990 or 1991. I never understood why patients weren't automatically given a copy of the records. Now it seems like most records are electronic. My PCP was able to get records from quite awhile back after I signed a release but probably not that far. She does have adhesions mentioned in my records so at least she recognizes that I have them.
When the passing of gas through the bladder began after my vaginal hysterectomy back in 1998 I was referred to a C/R place where they acted like I was crazy when I told them about it. They did do some tests but once again I got no copies and they didn't seem to have much to say but with the dismissive attitude they seemed to have about it from the start I wasn't surprised. Makes me wonder if people who work in the specialty of C/R don't really like their profession?
I've also wondered if it was a mistake for telling them that the problem started after a surgical procedure, if that is somehow offensive to them. But at the same time I feel like I should be totally honest about all of the details. The gynecological surgeon who did the vaginal hysterectomy wouldn't give me the time of day afterwards. My follow-up appointments were a joke and he never once sat down with me for any questions or discussions. Just ran in and out while I was in the stirrups. I should have insisted on a traditional laparascopic hysterectomy since I already had issues in the groin area.
As far as the visceral massage and physical therapists go I have found that Drs have no respect for what they have to say which I find ironic because sometimes Drs actually tell you to go to them.
I have gone to the ER a couple of times in the past year during my episodes of generally feeling unwell. All they found was low potassium levels but they didn't connect it to the fact that I was having long term massive diarrhea which I believe was caused by the Amoxicillin I took in 2024. I am now on a prescription supplement for that but my other symptoms remain. I did feel at times that my insides were being damaged- like one might have with inflammatory bowel disease- but hard to say if any evidence of that will show up on whatever testing the gastroenterologist might order which I assume will be a colonoscopy. Not sure if that is the best test or not since it only shows the inside of the colon. If there are any small areas of leakage I don't know how obvious they would be. I know that I should just stick to my symptoms and not mention things like abscess and fistula but that approach doesn't always work either.
When I mentioned the upper left abdominal swelling and sense of fluid moving around to my PCP I think she thought I was nuts.

One bad thing about the leg swelling is that I have a history of a blood clot that caused a pulmonary embolism and likely TIA 8 years ago. The blood clot was in my other leg. Once you've had a blood clot your chances of getting more go up. Since my left leg is always sore and swollen it could make it difficult to detect if I had a blood clot which IMO should make it even more important to resolve the issue. I had an ultrasound on it a couple of months ago when it was hurting pretty bad but fortunately turned out negative for a blood clot even though a D-Dimer test showed elevation.

@avocado1, I can understand why those past experiences would make you wonder how much to say at this appointment. I do think the timing matters, though. Telling the gastroenterologist that the bladder symptoms began after your hysterectomy isn’t the same as saying the surgery caused them. It gives the doctor part of the history and lets them decide what may or may not be relevant.

You also don’t have to choose the test yourself. You can describe what you are experiencing — including passing gas through the bladder, the abdominal swelling and sensation of fluid moving, drainage, bowel changes, and when each began — and ask what testing would best evaluate those symptoms. I think your question about whether a colonoscopy alone would answer everything is also a reasonable one to bring to the gastroenterologist.

The history of a blood clot and pulmonary embolism adds another concern, especially with ongoing swelling and soreness in one leg. It’s good that the ultrasound a couple of months ago was negative. If that leg becomes newly or significantly more swollen, painful, warm or discolored, or you develop new shortness of breath, chest pain, fainting or other acute symptoms, I wouldn’t wait for the GI appointment to have that evaluated.

You have a lot of history to convey at this appointment. Would it help to make a short timeline of the major symptoms, when they began, and the testing you’ve already had so the gastroenterologist can see the whole picture without you having to explain everything from memory?

I am trying to write things down but it can be hard to keep things short when you've been dealing with all these things over so many decades. In the past my advance preparation never did much good. It seemed that the appointments went way too fast and the Drs weren't very good listeners or they had their own agendas as to what they wanted to do regardless if it was best for my symptoms. I'm not knocking pelvic floor dysfunction but it seemed like that was being pushed pretty hard whether it seemed right for my symptoms or not. It never made sense to me that they would do a colonoscopy at the drop of a hat yet if you asked for something different- like an investigation into a fistula like the blue dye test- they would immediately dismiss it. I can only assume that $$$ has something to do with it.

Besides the passage of gas through the bladder, I got a lot of UTIs after the vaginal hysterectomy. Microscopic blood was being found in the urine. They did a pyelogram test to check the kidneys but found nothing. On occasion when I have loose stool I end up with more to clean on my front side than my back and I am thinking it is from the vagina. It happened last night a few hours after I had taken some senna and I guess laxatives can be hard on the gut lining. Whenever I mentioned passing gas through the bladder I was laughed or scoffed at- even at a C/R practice where that kind of thing should have been part of their specialty. From what I've read from other women who have had these types of problems it sounds like there are very few in the medical field who even want to deal with it and those that do don't seem to have very good success with it. Also major issues with mesh when it is used. I don't think I would subject myself to possibly worsening it. My vaginal hysterectomy caused enough damage and as I said that surgeon refused to sit down and speak with me at all afterwards.

I am trying homeopathy for the fistula on the advice of an alternative medicine practitioner. I am tempted to cancel my gastroenterologist appointment next week and no doubt he will want to do a colonoscopy which frankly I don't even feel physically up to right now and am concerned that it could aggravate things. I'd be OK going to him to see what he might have to say but don't want to be pressured into doing anything.

@avocado1, what would you most want the gastroenterologist to answer for you at this first appointment if you treated it as a consultation rather than deciding about a colonoscopy beforehand? If you can narrow down what you’re hoping to learn or decide at that visit, other members here may also be able to share experiences that speak more directly to those questions.