Bile Duct stones OR Gastric ulcer?

  Around 2 years ago I had my gallbladder removed. Before the surgery they performed an ERCP to look for bile duct stones, but never found any. Instead I ended up with a severe pancreatitis attack and hospitalized for 2 weeks.  I had severe diarhea (diarrhea) for almost a year after the surgery, then it subsided. Around 5 months ago I went back on the birth control pill. Since then, I have began to get the same upper right abdominal pains that I would experience before my gallbladder removal. The pain comes and goes, but recently the pain lasted for an entire week before it subsided. I finally went to a doctor, and he thinks it might be an ulcer or bile duct stones.  Would an ulcer cause consentrated pain in the upper right quadrant like this? I am supposed to see a gastroenterologist, but what will he do to determine this? Also what can they do if I still do have bile duct stones there? I don't want surgery again, as I have 3 young children to care for.
  Please help with any advise. Thank you!
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Dear Markey,
It is difficult to be certain what is causing your pain.  I am guessing that your pancreatitis was a complication of the ERCP and was not related to common bile duct stones.  Although ulcers do not usually cause the pain pattern that you describe, it is possible, on occasion, to get atypical pains particularly with pyloric channel ulcers.  An upper endoscopy could easily and safely resolve the question whether you have a peptic ulcer.
The more difficult issue is the cause of your pain if your endoscopy is normal.  One of the possibilities is a common duct stone.  Another explanation is pain from chronic pancreatitis.  I understand your reluctance to risk another ERCP.  I would suggest that you first have repeat liver and pancreas tests and a CAT scan of the abdomen.  If all these tests are normal and your pain has subsided, I would not do additional tests at this time.  If, however, you are still suffering from pain, then you should consider a repeat ERCP.  If you have common duct stones, a cut can be made at the end of the bile duct during the ERCP.  Stones usually leave the bile duct after this procedure.  Surgery is therefore avoided.
Best of luck
HFHSM.D.-rf
*keywords: abdominal pain, pancreratitis, ERCP, gall stones
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