Case of the month #12: Visceral Pain

Published: 01/02/2022


A 65-year-old lady presents with severe abdominal pain and bloating. This has been ongoing for over two years.  She describes that the pain is mainly in the left iliac fossa, sharp stabs of pain on a back ground of a constant belly ache.  She is very distressed in particular about the bloating associated with the pain. She is otherwise very slim and her abdomen is visibly distended even through loose clothing.

Of note she suffers from tablet-controlled diabetes for which she takes Metformin.  She has been extensively investigated by the gastroenterologists and has had a gastroscopy and colonoscopy with no abnormal macro or microscopic findings.   She does however report that she was told that the doctor doing the colonoscopy could not see much beyond the splenic flexure as her bowels had not been clear enough.  She also had a CT scan of the chest, abdomen and pelvis, which had shown mild diverticular disease of the sigmoid colon but nil else of concern in her internal organs.

She had no urinary or gynaecological symptoms.  She reported that she opens her bowels every few days and always passed very large bulky stools.  


  • What other questions would you like to ask when you first meet this lady in your clinic?
  • What measurement tools may be useful on your first and subsequent encounters?
  •  What management options might be useful?