Brief Answer: Possibility of colitis to be considered Detailed Answer: Dear Ms. XXXXX, Going by the description of pain one of the possibility i could think in your case is possibility 1. Colitis being the cause of symptoms. Colitis can sometimes present only with vague pain, bowel disturbances may be absent. Do you have any bowel disturbance like loose stools, offensive smelling stools, blood or mucous in stool? if you have the these symptoms too, its most likely colitis. 2. Inguinal Hernia- Other cause of pain in left flank region radiating to groin could be inguinal hernia. It can be diagnosed by good clinical examination, and presence of swelling above the groin fold. Its unlikely to be ruptured vessel in the abdominal wall, as a localized collection of blood-Hematoma would definitely have been picked up by Ultrasound /CT scan which you have already undergone. But still i would not exclude that as the diagnosis. Thorough inspection and examination of groin area will help. I would also suggest you to undergo workup for cause of bruising,especially if you have no history of trauma. Platelet Count, Platelet function test, Prthrombin time/ Activated partial Thromboplastin time (PT/APTT time) are the minimum investigation required for workup of brusising if not associated with trauma. I hope it helped Get back to me if you have any other query. Wishing you a healthy Life and recovery from ailment Take care Regards Dr Deepak Kishore MBBS,MS,MCH Consultant Surgeon

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Brief Answer: good clinical examination and stool examination Detailed Answer: Namaste Greetings of the day I do understand the suffering and trauma you are undergoing because of pain. Coming to your query 1. Only when colitis is severe,it can be picked up by contrast CT scan. Diagnosis of colitis is usually based on typical clinical history of vague lower abdominal pain, increased bowel movements, blood/mucous in stools. The diagnosis is substantiated/confirmed by presence of pus cells/mucous/blood in stool examination and also by typical colonoscopy findings. The diagnosis in your case will depend on good thorough clinical examination of the site of pain and appropriate investigation. Clinical examination will definitely reveal if there is hernia by inspection and swelling being obvious on coughing. I would once again stress the importance of good clinical examination. The investigation I would suggest is 1. Stool examination- Routine microscopic examination for ova/cyst/pus cells/mucous and stool for occult blood. 2. Ultrasound examination- have they looked out for inguinal hernia/left deep inguinal ring to rule out inguinal hernia as cause of symptoms in ultrasound scan which you have undergone? 3. Colonoscopy- it's especially indicated if you have bowel symptoms like alteration in bowel habits,urgency, sense of incomplete evacuation of bowel. Dizziness is unlikely to be present in both these condition. I would suggest you to get a Random blood sugar examination to rule out altered sugar level as the cause of symptoms. Clinical picture/video of both the inguinal region in standing position while coughing could give clue to presence of inguinal hernia. I suggest you to see your surgeon/physician and discuss the cause . Wishing you a healthy and pain free life. Do get back to me for any further assistance Take care Regards Dr Deepak

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Brief Answer: Stool examination and colonoscopy Detailed Answer: Greetings Would suggest you to go ahead with stool examination and colonoscopy Take care Regards Deepak

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