The 22-year-old woman almost wept as the long line of passengers finally surged forward to the front of the plane. She had been in pain for the entire 90-minute flight. Her abdomen was so distended and tender that she felt as if it might burst. Her seatmates had hidden their irritation as she shifted constantly in her seat in search of a comfortable position. The man in the aisle seat stood up each time she made her way to the bathroom. It didn’t do any good. Nothing came out. Not even gas.
The Charlotte Douglas International Airport in North Carolina stretched endlessly before her as she hefted her bulky knapsack from one shoulder to the other. Every step jostled her guts uncomfortably. Even without the weight of the pack, standing up straight was strangely difficult, as if a cord inside her was suddenly shorter.
She found her mother’s car in the line of idling vehicles outside. As she lowered herself into the passenger seat, her mother turned to her. “What’s wrong?” she asked. The young woman’s face looked rigid with pain. It was her stomach, the young woman said. As usual. She’d had problems with her stomach all her life. Going to the bathroom regularly had been an issue for years. Milk gave her cramps. Acidic foods gave her heartburn. And her stomach was always off after her college swim-team practices. She blamed the mouthfuls of chlorinated water that forced their way in as she sprinted the length of the pool. That at least was over, as she had graduated a few weeks earlier. Both mother and daughter assumed she just had a sensitive stomach. And their pediatrician agreed. It all seemed normal enough.
But a few months earlier, the mother noticed a change. A couple of times in their weekly conversations, the symptoms her daughter complained about sounded different — and a lot worse. The girl had always mentioned her sensitive stomach. Now she described constipation, bloating and intermittent, terrible pain. Once, her daughter sounded so awful over the phone that her mother became worried and suggested she go to the emergency room. But these pains never lasted long, her daughter assured her. Seeing her now, clearly in distress, the mother was concerned again. And again her daughter tried to reassure her: She had started to feel better as soon as she left the airplane, she said. What she needed now was a good night’s sleep.
This Time It Didn’t Pass
The next morning, she was better, though her mother could see that her stomach was still distended. She ate breakfast eagerly and settled in for a day of relaxing. But by late afternoon, the young woman could feel the symptoms returning. She could only eat a couple of mouthfuls of dinner. Her abdomen grew even larger than it had been the night before. The pressure was almost unbearable. She paced around the house, unable to sit but in pain when she walked. It felt as if her abdomen might explode and some terrible sci-fi creature would burst out. She tried going to the bathroom; she hadn’t moved her bowels in days. Nothing. She tried to make herself vomit. She heaved but only produced a sharp acidic mouthful of bile. She felt cold, then hot, then cold again. Sweat dripped down her face and drenched her shirt. Her mother, seeing the daughter’s distress, brought cool compresses and suggested going to the hospital again and again, her daughter deferring every time.
She took a laxative. It didn’t help. She lay down and, when that was too painful, resumed her restless pacing. “It’s not getting better,” her mother announced at last. “We have to go to the E.R.”
It was near midnight when they arrived at the small Southpark extension of the Atrium Health Carolinas Medical Center, and the waiting room was practically empty. She was seen almost immediately. A young doctor entered the room and introduced himself. The patient described the strange bouts of bloating, constipation and pain over the past couple of months. She couldn’t identify a trigger, and they had always resolved on their own until that night.
On examination, her blood pressure was sky high — probably because of the pain, the nurse told her when she saw the young woman’s alarm. Her abdomen bulged upward as she lay on the exam table. It made a strangely hollow noise when the doctor tapped on it. He heard nothing when he placed the stethoscope on her midsection, listening for the noises indicating the gut was functioning. He moved the instrument and listened again — this time for more than a minute. Finally, he heard a tiny gurgle. Her gut was still working, although clearly not normally. Her blood and urine tests were unremarkable. When the doctor returned, he didn’t have much to tell them. He wasn’t sure what was going on and said that the only other test they could try was a CT scan. It probably wouldn’t show much but was still worth doing. If this was appendicitis or some kind of a mass, they would see it.
A Real Emergency
The doctor came back with the scan results looking a little puzzled. “You have what is called a volvulus,” he intoned gravely. Her lower intestines had twisted themselves into something of a knot. No food could get through and it looked as if blood was having a hard time getting through as well. This was serious. A real emergency, he told mother and daughter. They didn’t usually see this disorder in young people. He had discussed her scan with the surgeon on call, and the recommendation was clear: Her gut had to be untwisted at the main hospital in Charlotte that night.
Volvulus occurs when a segment of the colon — usually the sigmoid colon, which is the part just before the rectum — becomes twisted around itself and sometimes the arteries that provide its blood supply. It is an unusual disorder in the United States and is most commonly seen in older adults, usually men, usually over 60. In these more predictable cases, a sedentary lifestyle and chronic constipation are important risk factors. In young people, it is sometimes linked to abnormalities in anatomy: a segment of the colon that is too long or sometimes increased laxity in the arteries, which typically anchor the gastrointestinal tract and prevent too much movement in the abdominal cavity. Symptoms of volvulus include bloating and distention — caused by the gas produced by the normal organisms in the gut, which becomes trapped between the two areas of twisting — as well as nausea, pain and sometimes fever. A volvulus can sometimes resolve on its own, which would explain the intermittent nature of her pain over the previous months. But not this time. The flight, with its reduced cabin pressure, may have worsened the bloating, tightening the twist as the captured gases expanded.
She arrived at the main hospital at an hour the girl usually associated with her college parties; it was almost dawn when two surgeons introduced themselves. They would use a camera-guided catheter to open the twisted ends and release the entrapped gas and intestinal contents. The scope could then rotate the gut back to its normal position.
When the patient awoke, her abdomen looked and felt nearly normal. The surgeons told mother and daughter that she’d need an additional operation to make sure it didn’t twist again. But the following day, her stomach grew once more to its towering height, and the terrible pressure returned. A second CT showed what she already knew: The gut had retwisted itself. That night, she went again to the operating room to have it untwisted. Two days later, back in the O.R., 18 inches of her lower intestines were removed and the two ends were sewed back together. The cause of the volvulus was unclear — there had been no sign of any anatomic abnormality — but the surgery ensured it would not happen again. By the time she left the hospital two days later, she was feeling pretty good. She had no bloating, and she could eat. The only pain she had was from the incision across her lower abdomen.
The surgery was two and a half years ago. She still has the same sensitive stomach she has always had. She still can’t eat dairy or gluten. Still feels queasy after she has pushed herself hard in the pool. But she has accepted that that’s just who she is. And the six-inch scar is her only reminder that there was ever anything more.
#Bloating #Stomach #Pain #Unbearable #Stop
