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Forum Name: Gastroenterology Topics

Question: LLQ pain, rectal bleeding in 22 y.o.


 dixieagle - Thu Jan 04, 2007 6:56 pm

My 22 year old daughter just came back from the gastroenterologist who has scheduled her for a colonoscopy to try and determine the cause of persistent pain in her lower left quadrant (quite low) and some mild rectal bleeding that is apparently "higher up" than that from hemorrhoids, according to the doctor. The pain resembles a hard pinch, and the area was quite tender to the touch when the doctor pressed on it during the exam. She had a colonoscopy three years ago which found hemorrhoids but nothing else. She has had no apparent fever, and she had blood work done today (no results yet.)

The pain has been there for a while, and she thought it might have been her ovary, and has had an ultrasound which showed nothing. (Actually, the poor kid has had abdominal ultrasound, a transvaginal ultrasound, an abdominal CT, and an endoscopy all in the last year.) She has GERD, a hiatal hernia and likely IBS. I have diverticular disease (she would be really young for that, but who knows, with everything else!)

My main concern is this; what would be the chances of it being colon cancer at her age, especially considering the colonoscopy in 2003? Her doctor mentioned possible colitis, diverticulitis, etc. Her dad has an autoimmune disorder (ankylosing spondylitis) and i wonder if that could contribute to her developing colitis.

Thanks for any insight.

Marie
 Dr. Safaa Mahmoud - Thu Jan 04, 2007 9:32 pm

User avatar Hello,

Fresh Blood in stools, are usually due to lower GI bleeding.

Causes include
- Hemorrhoids or piles and Anorectal fissures as well can result in Bleeding per rectum and are easily diagnosed. (Excluded by her doctor)

- Inflammation of the mucosa lining the rectum or the rectum and colon a condition known as proctitis or proctocolitis respectively.
These conditions are either due to infectious diseases or non infectious disease as a part of inflammatory bowel disease (including Crohn's disease and Ulcerative colitis)

Diagnostic tests include stool analysis to check for parasites and protozoa. Samples are collected before receiving any medication and should be repeated for 3 times to find the possible organism causing the infection.

Other tests according to the suspected cause like segmoidoscopy and Colonoscopy to visualize the lining mucosa and take biopsy if needed.

- Irritable bowel syndrome IBS,
Commonly people who have IBS complain off
Abdominal pain or colic
A bloated abdomen
Gaseous distension
Either Diarrhea or Constipation or an alternating between both of them
Mucus or less commonly blood containing stools.

- Other diseases that can give similar pictures to IBS and have to be excluded are Gastritis, GERD, and Peptic ulcer. But Blood in stools is usually occult and not fresh red.

- Polyps, diverticulosis and Colon cancer.
The risk of developing colorectal tumors starts at age 40 years.
Colonoscopy is of choice in the diagnosis of these cases.

It is unlikely to be related to her father illness. Ankylosing spondylitis is genetically determined but other factors play a role in the disease occurrence. The disease also affects mainly the joints.

Only by complete history, physical examination and investigations, the correct diagnosis can be reached.

Keep us updated.
Best regards,

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