instruction: hi doctor my sister is 46 years old now she got married 17 years back and have a girl child of age 15 for nearly 10 years she is having abdominal pain which will occur during the periods and will last for five days it will start two days before periods and will last three or four days after it the pain will be more and sometimes intolerable it will not even reduce with painkiller and the pain will be more during night time with the following symptoms lack of appetite lower abdominal pain breathing difficulty indigestion bolting and constipation all these symptoms will persist until the pain is there she had been frequently visiting doctors for treatment but the doctor says that she has no major problem in the stomach she was diagnosed with fibroid 10 years back and the size was small the doctors also said that the fibroid will not have pain as she feel whenever the pain is more she used to visits the hospital it will be six to seven visit a year and yearly once she will be treated with antibiotics for severe infection during her last period 30 days back the pain started and did not reduce until now the pain was so severe and for the last four days she had mild fever so she visited a doctor and he advised for a it scan after seeing the results he suggested to immediately go for surgery and advised to get her uterus removed and also said she might have cancer when we went for a second opinion to another doctor she said there is some uterus infection and advised medicine for that and asked to come back after two weeks I have attached the it scan and report kindly comment on it based on the results is there a chance of cancer which the local doctor has said the problem exists for nearly 10 years and many times due to intolerable pain she used to roll on the floor is there any permanent cure for it I have attached the prescription too can we continue it or should go for further investigations why infections reappear yearly as advised by the local doctor is removal of the uterus is necessary will it give a permanent solution please suggest me if any other investigation or treatment is needed or to be followed
output: hi after going through the detailed information given by you the issues I think need resolution are as follows regarding fibroid it need removal as that is an important cause of pain abdomen it can be done laparoscopically at this age my suggestion is to remove the uterus instead of the fibroid alone for pancreatic lipoma you should get a second opinion on this with gastroenterology specialists before planning fibroid surgery vaginal infections can be tackled easily it is not a major concern after gastroenterologist opinion we will plan for mri scan if required endometrial biopsy or dilation and curettage with pap smear is mandatory prior to definitive surgery hysterectomy revert back for further doubts to an obstetrician and gynaecologist online