Potential ongoing case study

Hello Doctors,

I’m currently in a bit of a predicament health-wise and was hoping for any insight you may be able to provide. I’ll try to keep it short and include relevant details. 38 y/o male, 6’3”, 225 lbs.

On the night of June 4 (a Tues) I began to experience mild cramping in the abdomen (mainly around the belly button), which increased in severity over the next 3 days to the point where I was unable to get out of bed, eat, or sleep due to the pain/discomfort (Fri-Sun). The pain would vary from a light cramping near the belly button, to full stabbing pain throughout the abdomen (ribs to pelvis), front and back. The only relief came from lying face down/flat with a heat pad on my lower back. Because this was paired with diarrhea/mucous-y stool, I suspected some type of gastro, and managed the pain as best as I could with symptoms improving after the weekend, until the night of June 11, when they returned in full. I went into the ER on June 12 and after bloodwork/urine analysis (both came back negative, WBC and CRP showed nothing of concern) and a CT scan, I was diagnosed with appendicitis. After consulting with the surgeon I was told because the appendix wasn’t perforated and/or blocked, that this would be treatable with antibiotics, and though I was prepared for surgery, the surgeon’s advice stating that he saw no reason to remove it was enough for me to try the meds.

After beginning a 6 day course of amoxicillin clavulanate, symptoms settled over time and I experienced improvements to sleep, energy levels, and appetite (I had lost >10 lbs at this point). By the time I had finished the meds (June 18), I was 100% aside from one side-effect (ongoing diarrhea), which subsided shortly after concluding the prescription. I also had a follow up appointment with the surgeon, and was advised if the pain came back with more severity than the previous bout that I was to go back to the ER. In the early morning of June 29 (Sat), I was once again awakened by the exact same pain I had experienced previously, but on the lower end of severity. I attempted to manage symptoms over the weekend with a low FODMAP diet, beginning to suspect something else might be at play, but this had little correlative positive effect with symptoms. On Tuesday night (July 2), symptoms became much worse than previously experienced, and I went into the ER again yesterday (July 3) convinced that my appendicitis had not resolved. After the same tests were completed (WBC/CRP and urine again fine), a full abdomen CT came back negative. I was told the appendix appeared better when compared to the CT from 3 weeks prior, and that it showed no signs of kidney stones, ulcerative colitis, Crohn’s, or any other visible colorectal pathology. I was given a prescription for morphine sulfate to manage pain, and advised to keep my follow up appointment with my surgeon to proceed with upper/lower scoping. More blood was taken to test for H Pylori, and the only suggestion I was provided to possibly explain the symptoms was some sort of residual appendix pain.

I realize this is a lot and there is likely very little guidance you would feel comfortable providing. All that I ask is if any of this raises question/concern of something that may be overlooked that it would be helpful to know, and also if you feel I can continue to exercise within my limits without causing further detriment.

As always thank you so much for your time and attention.

Sorry to hear about this, certainly sounds like a frustrating situation.

The lack of elevation in CRP and essentially negative CT (assuming it was performed with IV contrast) is reassuring against a lot of dangerous pathologies. CT imaging is extremely useful in the evaluation of abdominal pain, but is not perfect to detect everything. It may have been a mild/early case of appendicitis that has been treated. Alternatively, there are conditions that can “mimic” appendicitis that may not be as easily identified including certain ileocecal infections, inflammatory bowel disease (especially Crohn’s), mesenteric adenitis, and much rarer conditions like angioedema and porphyria. This is not to say that any of these conditions are necessarily “likely” in your case based on what you’ve described, but that there are other possibilities that may require a bit more investigation if the symptoms persist. This could include additional imaging or endoscopic evaluation, as was mentioned to you.

Based on what you’ve described here, I do not see a clear reason to recommend exercise restrictions.

Thanks so much Austin for the detailed and reassuring reply, I can’t tell you how helpful it’s been to move forward without anxiety. Both CTs were indeed performed with IV contrast, and I have upper and lower scopes booked for Sept. Meanwhile symptoms have thankfully subsided, and I’ve been happily active and returned to normal diet/appetite a few days ago.