What could be causing my severe lower abdominal pain and cramping, given my history of intestinal issues due to adhesions?

Severe Lower Abdominal Pain with History of Adhesions

You need emergency surgical evaluation immediately—your severe pain that doubled you over, combined with your history of adhesions from previous surgeries, strongly suggests acute bowel obstruction, which can progress to life-threatening bowel ischemia or perforation within hours. 1

Why This Is Urgent

Your clinical presentation is classic for adhesive small bowel obstruction:

• History of previous abdominal surgery has 85% sensitivity and 78% specificity for predicting adhesive small bowel obstruction 1
• Adhesions cause 55-75% of all small bowel obstructions 1
• Severe, intense pain that is unresponsive to simple measures is a warning sign of bowel ischemia or strangulation, which carries mortality rates up to 25% if not promptly treated 2
• The progression from intermittent cramping to severe pain that doubles you over suggests worsening obstruction 1, 2

Critical Warning Signs to Monitor

You need immediate emergency department evaluation if you develop any of these:

• Fever, rapid heart rate, rapid breathing, or confusion (signs of ischemia/strangulation) 2
• Inability to pass gas or have bowel movements 2
• Vomiting, especially if it becomes green/yellow or feculent 1, 2
• Worsening abdominal distension 1, 2
• Pain that becomes constant rather than crampy 1

Why Adhesions Are Particularly Problematic

Adhesive obstruction from scar tissue is notoriously difficult to diagnose because it can be intermittent and may not always show up on imaging 1:

• The obstruction may resolve temporarily, only to recur 1
• A distinct transition point between dilated and normal bowel may not be visible on CT if the bowel is fixed by adhesions and cannot dilate 1
• Patients often find that sticking to a low-residue or liquid diet reduces obstructive episodes—if this has been your pattern, it strongly supports adhesive obstruction as the diagnosis 1
• The classic pattern is intermittent colicky pain with distension, loud bowel sounds, no bowel action, and vomiting, followed by diarrhea when the obstruction resolves 1

What Evaluation You Need

Do not wait for a routine appointment—go to the emergency department now for:

• CT scan of abdomen/pelvis with IV contrast (the diagnostic standard with >90% accuracy) 2
• Complete blood count to check for elevated white blood cells (suggesting ischemia) 1, 2
• Lactate level (elevated in bowel ischemia) 2
• Electrolyte panel and renal function (to assess dehydration) 2

The key diagnostic challenge: obtaining a CT scan during an episode of severe pain is crucial, as the obstruction may resolve between episodes and not be visible on delayed imaging 1

Common Pitfalls to Avoid

• Do not assume this is just "chronic pain" from your known adhesions—new severe pain represents acute obstruction until proven otherwise 1
• Do not take opioid pain medications, as they can worsen bowel obstruction and mask critical warning signs 1
• Do not delay seeking care hoping symptoms will resolve—1% of patients develop adhesive obstruction within one year of surgery, with half occurring in the first month, but obstruction can occur at any time, even decades later 3

Alternative Diagnoses to Consider (But Less Likely)

While adhesive obstruction is most likely given your history, emergency evaluation will also assess for:

• Fecal impaction (would show hard stool on rectal exam with "gush sign") 4
• Bowel ischemia without mechanical obstruction 1
• Strangulated internal hernia 1

Bottom line: Severe abdominal pain in someone with your surgical history is adhesive bowel obstruction until proven otherwise, and this requires emergency—not routine—evaluation. 1, 2