What is gallbladder stump syndrome?

[beebug]

I had my gallbladder removed 12 years ago.  I am having some symptoms. It has been suggested that I have gallbladder stump syndrome.  Can anyone tell me what this is and what the course of treatment would be?  Thanks so much.  beebug

[beebug]

Meg, I would ask your GI about gall bladder stump syndrome and/or thick bile.  That is what my doctor is leaning towards.  I too am experiencing upper right quadrant pain.  Keep me posted! Beebug

[Meg111]

I had a sphincterotomy done after my gallbladder was removed because x-rays showed a stone.  That doesn't seem to be helping my situation.  I probably don't have bile backup but might have scar tissue.  Still having pain frequently...about ready to go back to GI to ask more questions.  Any suggestions?

[beebug]

You have really been through it.  I went in for my bloodwork yesterday morning on the amylase. Haven't heard anything on it yet.  It is really bad to have all these symptoms and they cannot find anything wrong.  I have been down that road many times.  My doctors also argued on the ERCP bit, but one finally won out and did it.  I don't know if my amylase level has anything to do with the amylase elevation or not.  I will keep you posted!  Good luck!  Beebug

[5fan]

I had my gallbladder removed in July 2002 and have similar symptoms too!  

I have been rehospitalized for pain and had an MRCP that showed nothing.  I've had a HIDA scan, liver scan, pancreas scan, 2 CTs, 2 sonograms, 1 EGD, 2 gastric emtpying studies, small bowel follow thru, more blood work than imaginable, 2 sets of abdominal x-rays and so on and so on.

I had pancreatits before I had my gallbladder removed so everything took a little longer than ususal to get done.  I also had a nicked artery during my surgery so that didn't help.  At least I didn't have to have open (traditional) surgery.

At this time I have been referred by my local GI to a specialist at a university hospital to see if he can figure out what is going on.  The local GI thought I probably had level 3 sphincter of oddi dysfunction but is unable to test for it here so referred me to the specialist.

I saw the specialist on 12/23/02 he and the resident that worked my case with him had a "disagreement" about what course of treatment to take.  I have not had an ERCP done.  The resident wanted to do one ASAP, the specialist did not.  The specialist feels that with my history I am at too high a risk to do an ERCP with manometry due to the risk of pancreatitis without exhausting other less invasive tests first.

I have had blood work done and he has diagnosed me with pancreatic insufficiency.  I also had a gastric emptying study done and he has determined that I have delayed gastric emptying.  I am now taking Erythromycin four times a day.  If after trying all four dosage levels of the Erythromycin I don't have relief he is then going to do a bowel motility test (where you swallow a "wire" and they monitor you for 24 hours as they feed you).  Depending on the results of that he will then consider whether or not he will proceed with an ERCP.

I have been extremely frustrated with the whole process.  I understand that whatever is wrong with me is not a cut and dry situation, but I am closing in on the year aniversary of my first attack and I really don't feel like I've made much progress.  I didn't have any of these problems before the attacks started and am having a hard time understanding why I'm having them now.  Now I can't eat anything without the whole right side of my abdomen distending and having pain.  My pain follows my rib cage to the sternum and radiates into the back.  I have pain on some level pretty close to 24 hours a day / 7 days a week.  The doctor has given me Ultracet for it but I find it pretty close to useless when the pain is bad.

I understanding that it isn't the doctor's fault - don't get me wrong.  I'm just really strugglying with "what next" and "when will there be releif".

Any help or insight anyone may be able to offer I would greatly appreciate.  I wish you all the best of luck!!!!

5fan

[beebug]

My MRCP showed nothing.  Doc said to get my amylase level checked again tomorrow.  Depending on what it is, he may put me on Actigall, a medicine that thins out the bile.  He thinks maybe my bile is real thick.  Does anyone know why in the the world a person's bile would be thick? I have never heard of this before.

[Meg111]

I have similar symptoms, gallbladder removed 6 months ago and still having URQ pain after eating.  I have narrowed it down to a few things...like coffee...but many times the pain comes without eating anything or drinking coffee.  I have been on Pepcid for almost 1 month...minimal improvement.

Please keep us posted on your progress.  Maybe it will help some of us to ask the right questions.

[beebug]

I ent to my doctor on Monday.  He did bloodwork and found that my serum amylase was elevated.  I was sent in for an MRCP last night.  What exactly will an MRCP show him? And does an elevated amylase always mean a pancreatic problem?  I do not have the results of the MRCP yet. Thanks. Beebug

[beebug]

Have you ever had any testing done for that problem?  Could be a blocked or tight bile duct.  Which can cause problems. I would pursue this.  I went back to my doctor today and he said I could have one of two things, either gall bladder stump syndrome, or where the doctor slit my bile duct to drain into my small intestine could have closed up again. I am awaiting blood results to hear his "plan of action".  Good luck!

[aniee1]

Hi

I also had my gallbladder taken out about 20 years ago. In the common duct area I suffer from spasms and a twisting pain at times. I ate steak last night and suffered badly from it. I started to bloat and then the pain. It was a twisting , pulling pain and I finally just had to go to bed. I seldom eat any red meat and when I do I suffer. I read that it is hard on the liver to digest proteins.  There has also been times when I have awoken from a deep sleep with severe spasms in this area.  I wonder if scar tissue is to blame or the common bile duct.....

[beebug]

Thanks so much for your reply.  I did have elevated liver enzymes for a year.  No test they performed showed anything until a doctor finally did an ercp and found my bile duct blocked by scar tissue and bad bile.  He opened that in November of 2002.  Since then I have have really bad "spasm pain" in my upper right quadrant.This usually happens, but not always, after I have started eating. This spasm pain has been worsening in the last 2 to 3 weeks. I have made an appointment with my doctor as you suggested and will see him Monday, the 10th.

[Kevin Pho, MD]

Hello - thanks for asking your question.

What you are describing is known as postcholecystectomy syndrome.  It requires a comprehensive workup by your personal physician.

The term postcholecystectomy syndrome (PCS) describes the presence of symptoms after cholecystectomy. These symptoms can represent either the continuation of symptoms thought to be caused by the gallbladder or the development of new symptoms normally attributed to the gallbladder. PCS also includes the development of symptoms caused by removal of the gallbladder.

Two types of problems may arise. The first problem is continuously increased bile flow into the upper GI tract, which may contribute to esophagitis and gastritis. The second consequence is related to the lower GI tract, where diarrhea and colicky lower abdominal pain may result. This article mainly addresses the general issues of PCS.

PCS reportedly affects about 10-15% of patients. A wide range of symptoms occurs. Symptoms are sometimes considered to be associated with the gallbladder. Colic is found in 93% of patients, pain in 76%, jaundice in 24%, and fever in 38%. The cause of PCS is identifiable in 95% of patients.

The workup for PCS is variable. An extensive study of the patient should be performed in an attempt to identify a specific cause for the symptoms and to exclude serious postcholecystectomy complications. Surgical reexploration should be considered a last resort.

The treatment depends on what is found on evaluation - it will vary depending on what the cause of your symptoms are.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Links:
http://www.reginadoctor.de/pch.htm