Stomach pain

Question

Dear expert team,
I am the mother of a girl (9 years old) who has been diagnosed with CF at the age of 9 month. My daughter has a mild lung disease and pancreatic insufficiency. She gets a "standard therapy" for CF (mucolytics, pancreatic enzymes, vitamins and antibioitcs according to need). In the last week, my daughter complained about stomach pain, especially in the region of the right lower abomen. She did not have fever, nausea, vomiting, diarrhea or infections of the airways in the last month. 2 ultrasound investigations have been done and my daughter has been consulted by 3 pediatricians and surgeons. The ultrasound showed that the liver, pancreas, gall bladder, kidney, appendix appered normal. Only a few enlarged lymph nodes in the mesenterium could be found. Investigation of the stool and Giardia antigen - negative. Further investigations have not bee done. The physicians diagnosed a mesenteric lymphadenitis and prescribed only a symptomatic therapy (Trimebutine Maleat, Drotaverinum, Ibuprofen). But these drugs did not help. My daughter still has stomach pain, especially in the evenings and at night.
Because I am not convinced that the right diagnose has been made I would like to ask you, which other investigations could we do in order to find the right diagnose.
In case this diagnose would be confirmed after all, I would like to ask you if this presecribed symptomtic therapy is correct and sufficient. As I said before, after one week my daughter still has strong stomach pain. Could antibiotics be helpful in this case?
Yours sincerely,

Answer

Hello,
your 9-year old daughter with CF suffered in the last week from stomach pain, especially in the right lower abdomen and especially in the evenings and at night. The investigations done did not show a clear diagnose, also the initiated therapy was not succesful so far.
For a detailed judgment, however, important information on the medical history and clinic are lacking. How often does your daughter have stool, does she tend rather to obstipation and did she take less fluid in within the last days? Does the consistancy of the stool changed in the last time? Important would also be information concerning the appetite and amount of taken pancreatic enzymes. Are the inflammatory parameters in the blood investigation increased? Also it would interest me, if the ultrasound investigation was able to give information about the region of the right lower abdomen, if e.g. there was a thickening of the bowel wall. Have any other imaging investigations been done?
Without such additional information, a judgment is difficult. If not already done, I would recommend urgently another control with the ultrasound.
As a possible diagnose there could come into account several changes which could occur typically in CF like, among others, a starting distal obstruction syndrome (DIOS), but also inflammatory changes of the bowel.
Because of lacking infromation/results, a therapeutic recommendation is difficult, in any case I would recommend that you should contact a CF-specialist with gastro-eneterologic experience.
Yours sincerely,
Dr. H. Ellemunter

05.10.2010