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Suggest Treatment For Severe Upper Right Quad Abdominal Pain

Posted on Wed, 29 Apr 2015

Question: I had severe sudden onset upper right quad abdominal pain April2. ER gave donnatol and sent home. Pain persisted so went to primary care and her Ultrasound showed small amount ascites around liver, morrisons pouch and pelvic cul de sac. Sent back to ER. Transvaginal US showed a 3cm complex cystic structure, on right ovary with with moderate free fluid. Also several simple cysts present on rt ovary. Rt ovary measures 5.9x2.8x4.6cm. Is that normal sized or enlarged? Left ovary not visible. Small free fluid in endocervical canal. 6mm echogenic hypervascular lesion found anterior to endometrial stripe near cervix and radiologist made a point to say it did not look like a fibroid or cesarean scar mass. CT with IV contrast showed no problems with liver or other abdominal organs and blood work supported that. Theory is the ascites is from the ovaries. Does this indicate ovarian cancer or can the ascites in abdomen be from a benign ovarian cause? When I research I can only find ascites from ovaries associated with ovarian cancer. I can't find a single case where ascites from benign ovarian source. Can this ascites be from a regular/ benign cyst. Also had enlarged mesenteric lymph nodes. 37 year old female. Level with me, does this paint a picture of ovarian cancer? I don't want to be shocked when I see Obgyn on Tuesday. Is it ok that I am at home and not hospitalized right now? Is my abdomen being washed in cancerous ascites fluid since April 2 and I can't see my doc until the april 7th?

Answered by Dr. Soumya (1 hour later)

Brief Answer:
Ovarian cancer or ruptured ovarian cyst. Needs to be tested

Detailed Answer:
Hello,

Thanks for your query.

I have read you query, saw the attached reports and I understand your concerns about the ascitic fluid and cyst in ovary.

There are 2 possibilities in this circumstances:

1) Ovarian cancer is a possibility seeing the CT scan and ultrasound scan reports. You need to undergo some blood tests and ascitic fluid cytology examination to check if this is ovarian cancer. Enlarged mesenteric lymph nodes also suggest possibility of cancer.

2) Ruptured ovarian cyst is another possibility which also presents with minimum fluid in Pouch of XXXXXXX This differential diagnosis has to be kept in mind regarding ovarian cyst if the tests reveal there is no cancer.

3) There is no need to go to ER . Even if this is cancer ( suppose) , this would have started long back and not recently. Hence it is not going to spread so fast. The ascitic fluid ( if has cancerous cells) would have washed abdomen by now and there is no new effect that is going to happen. You can wait till 7th April to see your doctor and no need to go to ER.

4) There is no need to get hospitalized as of now.

I hope I answered you query and addressed your concerns. Please keep posted about followup with your doctor also so that I can help you further with your doubts.

Let me know if you wish to ask any further questions. I will be glad to help you.

Regards,
Dr. Soumya

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Soumya (7 hours later)

Please tell me what to expect when I see my obGyn tomorrow. Which test should I need and ask for if he doesn't order them. he will have the exact same scans you saw and nothing more. What tests would you order if I were your patient? If it such a small amount of ascites, how can it be tested?

thanks for your quick reply Dr. XXXXXXX

Thanks,
XXXX

Answered by Dr. Soumya (27 minutes later)

Brief Answer:
Blood tests and ascitic fluid aspiration

Detailed Answer:
Hi

If you were my patient I would have aspirated ascitic fluid under ultrasound scan guidance and sent for cytology examination.

Its a simple test done in OPD.

Ask the same from your doctor. He will also run some blood tests for cancer diagnosis.

Let me know if you have any more questions.

Regards

Above answer was peer-reviewed by : Dr. Pradeep Vitta

Follow up: Dr. Soumya (2 days later)

I saw my obgyn. based on the same reports you see he said there is nothing at all to worry about and he has no plans to follow up or do any other imaging studies. my ca-125 was 29.8 and CEA was .5 He said these results prove I don't have ovarian or colon cancer.

He said it was a normal ovulation where a drop or two of blood escaped into abdomen causing pain. he said uterine lesion was a polyp and those are never cancerous. he said its not possible for a 3cm ovarian complex cyst to cause ascites and he thinks i don't have ascitesm, even though 3 reports say I do. He said it is the normal moisture that comes of the organs, like sweat. He did not do a pelvic or even touch me. He has no follow up planned. He will not give referral to gyno/oncology.

I don't know what to do. He is head of OB/gyn department at my medical group.

what do you suggest?

Answered by Dr. Soumya (5 hours later)

Brief Answer:
This is not cancer

Detailed Answer:
Hi

He could be right. That is the reason I had discussed with you that other option is possibility of non cancerous cyst rupture.

This is normal. Don't worry about it. You done need further testing.
Let me know if you need any more clarification.

Regards
Dr. Soumya

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Prasad