I am a 26 YOF s/p lap RNY gastric bypass 3/31/05, lap cholecystectomy 6/27/05. Since cholecystectomy I've had intermittent R shoulder pain mimicking prior gallbladder pain, assumed it was "phantom pain". In Jan the pain increased & became near-constant, coming on in the morning after a protein shake/breakfast & gradually worsening, esp. after meals. It does not change w/position or activity & is often accompanied by nausea. I also have intermittent sharp pain under R ribs similar to prior gallbladder pain. The RUQ pain was not bad at 1st but has gradually worsened, whereas the shoulder pain has been pretty constant. Not sure if it's related, but I've had orange/yellow diarrhea alt w/constipation, dizziness upon raising arms, and recently some cloudy urine w/out burning. Only prior med was Wellbutrin for smoking cessation. I lost an abnormal amount of weight when the diarrhea was particularly bad. Initially I saw my PCM (a PA at my clinic) he guessed it was muscular pain, tried to pop my back, & sent me home w/Flexeril & Lortab. I returned for follow-up, Flexeril made me sleepy, Lortab helped somewhat. Spine x-rays only showed mild scoliosis. Had a manipulation by physical therapist, no improvement. Mentioned nausea/RUQ, he prescribed Prevacid, did not help. Then I had an unusual problem when taking a large calcium pill-it felt stuck & the R shoulder pain became sharp when i swallowed. I also noticed that when the shoulder pain is bad, it radiates out through my chest. He then referred me to the bariatric surgeon who performed my RNY. He was confused by my symptoms, ordered bloodwork, CT scans, & referred me to a gastroenterologist for an EGD. The bloodwork was normal, CT scan only showed benign lesions in my lung. While waiting for the EGD I had an episode of severe pain radiating out my chest, almost went to the ER but held off, the next day he prescribed Hyoscyamine for esophageal spasms, no improvement. Had the EGD which found a small ulcer on RNY stoma, lump of benign scar tissue, Barrett's esophagus. Given Carafate, more Prevacid. Pain continues, followed up w/the doc who did the EGD. He mentioned sphincter of oddi dysfunction, ordered more bloodwork & MRCP, both negative. He called in a rx for Elavil, then scheduled an ERCP but the wait was 3 wks b/c he wanted to do it under general anesthesia. Given Darvocet for pain in the meantime. Today (2 days before ERCP) he called and said that he forgot about my bypass & ERCP is impossible b/c of it. I don't know how he forgot (he did my EGD!) & i've spoken to someone in a RNY support group who had an ERCP after RNY. She was only sedated & woke up during it but it helped & she feels fine now so I was hopeful that I would too. He sounds like he's given up on me, he doesn't think it's SOD anymore and doesn't think i'm a surgical candidate b/c of negative bloodwork/MRCP. (yet he called MRCP "poor man's ERCP") I feel abandonded & i'm still in pain. What do I do now??
I am not a surgeon, so my insight into this question is limited.
To my knowledge, I am not aware that the procedure you had is a contraindication to an ERCP.
If there is concern about SOD, one can consider various provocation tests - such as a fatty meal ultrasound. This test is typically done in those without a gallbladder, and can correlate with SOD. Keep in mind however that the correlation between this test and manometry is not 100% accurate.
I would discuss this option with your personal physician - or consider a second opinion with another surgeon.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
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