Question

I have been having severe abdominal cramps followed by vomiting bile. I have been to the hospital on three occasions with this. They have taken many x-rays and done lots of tests. One doctor said I had a small bowel obstruction. I am 57 and female. Thanks for any information that you can give me.

Answer

Your symptoms of intermittent abdominal cramps followed by nausea and vomiting is very typical of a bowel obstruction. This is especially suspicious if the pain is centered in the middle of the abdomen. The most common point of obstruction is in the small intestine.

Common causes of small bowel obstruction include adhesions (scar tissue from prior abdominal operations), hernias, and tumors of the bowel (benign or malignant). Evaluation of a patient with suspected small bowel obstruction when they are ill should be straightforward and the diagnosis is usually made by physical examination and x-rays.

Sometimes the diagnosis can be more difficult. One potential condition is pancreatitis, which can present with abdominal pain, nausea, and vomiting. The pain classically begins in the abdomen and radiates to the back. The pain is usually in the upper abdomen and constant.

Gallbladder disease (colic) can also present with severe upper abdominal or right upper abdominal pain, nausea, and vomiting. The pain may radiate to the scapula (shoulder blade) or the shoulder. Blood tests, ultrasound and/or a CT of the abdomen can diagnose pancreatitis and gall bladder disease.

Stomach or duodenal ulcers can also present with the symptoms mentioned. Endoscopy is the most accurate way to diagnose them.

Finally, metabolic and inflammatory disorders must be considered in cases of intermittent pain and vomiting. Inflammatory diseases may include conditions such as Crohn's disease of the small intestine, lupus, and other autoimmune disorders. Metabolic disorders include diabetes, thyroid disorders, and kidney disorders, to name just a few.

You should be seen by a gastrointestinal specialist to have a thorough evaluation of your symptoms. This should be done as soon as possible in order to prevent future attacks.