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RLQ Abdominal Pain

Posted by subhi @subhi, Sep 19, 2017

i have 12 yrs daughter ,she is suffering from sever pain in iliac fossa ,sever rebound tenderness in it ,fever ,myalgia , joint pain ,nausea & vomiting.
1st diagnose was constipation.but with laxatives no improvement.
2nd diagnose was FMF ,but with colchicine no improvement
appendectomy was done.to rule out appendicitis
meckel's disease , ileal intussusception & crohn's were ruled out.
all CT ,MRI ,abdomen u/s and , tests(CBC,KFT,LFT,ESR,CRP),urine analysis & Stool analysis were normal.
only one thing is found :edematous mesentery.
so I need your help for right diagnose .

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subhi | @subhi | Sep 19, 2017

each attack lasts for 2-3 weeks
one week free except rebound tenderness

REPLY
Kanaaz Pereira, Connect Moderator | @kanaazpereira | Sep 19, 2017

Hello @subhi

Welcome to Connect. I'm so sorry to hear about your daughter's struggles. Here is some information from Mayo Clinic, about mesenteric lymphadenitis or mesenteric adenitis (which is very similar to mesenteric edema): http://www.mayoclinic.org/diseases-conditions/mesenteric-lymphadenitis/home/ovc-20214655

Although it is in a different group on Connect, you may wish to view this discussion:
– My 11 year old has mesenteric adenitis. Chronic Migraine and dizziness https://connect.mayoclinic.org/discussion/my-11-year-old-has-mesenteric-adenitis-chronic-migraine-and-dizziness-for/

In this discussion, "Deficient disaccharidase & inflammation in small intestine" https://connect.mayoclinic.org/discussion/deficient-disaccharidase-inflammation-in-small-intestine/, you will meet @fa7100 and @jay_baruch who may have more insight for you.

I'm also tagging Connect's Mentor, @kariulrich as she may have some thoughts to share.

@subhi, is your daughter taking any medication to help with the stomach pain? Did the doctors rule out viral infection, such as gastroenteritis (stomach flu) as an underlying cause?

REPLY
1 reply
subhi | @subhi | Sep 19, 2017
In reply to @kanaazpereira "Hello @subhi Welcome to Connect. I'm so sorry to hear about your daughter's struggles. Here is..." + (show)
@kanaazpereira

Hello @subhi

Welcome to Connect. I'm so sorry to hear about your daughter's struggles. Here is some information from Mayo Clinic, about mesenteric lymphadenitis or mesenteric adenitis (which is very similar to mesenteric edema): http://www.mayoclinic.org/diseases-conditions/mesenteric-lymphadenitis/home/ovc-20214655

Although it is in a different group on Connect, you may wish to view this discussion:
– My 11 year old has mesenteric adenitis. Chronic Migraine and dizziness https://connect.mayoclinic.org/discussion/my-11-year-old-has-mesenteric-adenitis-chronic-migraine-and-dizziness-for/

In this discussion, "Deficient disaccharidase & inflammation in small intestine" https://connect.mayoclinic.org/discussion/deficient-disaccharidase-inflammation-in-small-intestine/, you will meet @fa7100 and @jay_baruch who may have more insight for you.

I'm also tagging Connect's Mentor, @kariulrich as she may have some thoughts to share.

@subhi, is your daughter taking any medication to help with the stomach pain? Did the doctors rule out viral infection, such as gastroenteritis (stomach flu) as an underlying cause?

Jump to this post

Thanks
She takes ranitidine 150 once daily
Also flu stomach is ruled out

REPLY
subhi | @subhi | Sep 19, 2017

New blood tests results:
Albumin 5 g/dl
ESR 40 mm/h
Platelets 470 000
Leucocytes 9800
Hb 11.5 g/dl
KFT , LFT are normal
Microscopic urine examination:
WBC. 6-8/HPF
RBC 3-5 /HPF
Epith.cell :present
Mucus :present

REPLY
Kari Ulrich, Alumna Mentor | @kariulrich | Sep 19, 2017

Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we are here to support you both. It sounds like she has had a big GI work up, I am curious with her joint pain and fever if she has seen a rheumatologist yet? Have you had a second or third opinion on her symptoms? Has she been able to maintain weight? You are being an amazing advocate for your daughter, keep asking questions and know we are here to listen. For nausea what I use is ginger-ail, or ginger candies. It is the only thing that helps control my nausea.

REPLY
3 replies
subhi | @subhi | Sep 20, 2017
In reply to @kariulrich "Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we..." + (show)
@kariulrich

Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we are here to support you both. It sounds like she has had a big GI work up, I am curious with her joint pain and fever if she has seen a rheumatologist yet? Have you had a second or third opinion on her symptoms? Has she been able to maintain weight? You are being an amazing advocate for your daughter, keep asking questions and know we are here to listen. For nausea what I use is ginger-ail, or ginger candies. It is the only thing that helps control my nausea.

Jump to this post

Thanks @kariulrich ,
my daughter was seen by:
Family medicine specialist
GI specialist
Paed GI specialist
rheumatologist
Urologist
nephrologist
General surgeon
but no one knows what is the right diagnosis
the Paediatrician GI specialist insisted on FMF and she should take Colchicine 1 mg*2
I need your help to advise me who is the specialist I should ask.
the only one that I didn't ask him was Neurologist .

REPLY
Kari Ulrich, Alumna Mentor | @kariulrich | Sep 20, 2017
In reply to @kariulrich "Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we..." + (show)
@kariulrich

Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we are here to support you both. It sounds like she has had a big GI work up, I am curious with her joint pain and fever if she has seen a rheumatologist yet? Have you had a second or third opinion on her symptoms? Has she been able to maintain weight? You are being an amazing advocate for your daughter, keep asking questions and know we are here to listen. For nausea what I use is ginger-ail, or ginger candies. It is the only thing that helps control my nausea.

Jump to this post

You and your daughter have indeed seen every specialist under the sun! Could you tell me what FMF is? I am not familiar with that abbreviation. Are all the doctors consulting with one another? May I ask where you are from, we get messages from patients all over the world and it gives me a better idea what health care system you are using. I am thinking of you and your daughter. Stay strong, easier said than done!

REPLY
Kari Ulrich, Alumna Mentor | @kariulrich | Sep 20, 2017
In reply to @kariulrich "Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we..." + (show)
@kariulrich

Welcome @subhi, I am sorry to hear about your daughter! Although we cannot help diagnosis, we are here to support you both. It sounds like she has had a big GI work up, I am curious with her joint pain and fever if she has seen a rheumatologist yet? Have you had a second or third opinion on her symptoms? Has she been able to maintain weight? You are being an amazing advocate for your daughter, keep asking questions and know we are here to listen. For nausea what I use is ginger-ail, or ginger candies. It is the only thing that helps control my nausea.

Jump to this post

Is this what the doctors are thinking she has FMF? http://www.mayoclinic.org/diseases-conditions/familial-mediterranean-fever/basics/definition/con-20025734 If so I would belive a genetic doctor visit maybe a good idea.

REPLY
Kari Ulrich, Alumna Mentor | @kariulrich | Sep 20, 2017

Here is an overview of what genetics is about if you are not familiar with this type of medicine. Genetics can be an overwhelming topic! I have a genetic doctor on my team of specialists, Mayo does a great job at making sure patients have an understanding of how they can help and what their limits are. I hope you find this helpful.

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