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post cholecystectomy syndrome and SOD
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post cholecystectomy syndrome and SOD

Hello. I am A 40 year old normal weight female who had my gallbladder out two months ago after an episode of acute cholecystitis. I was pretty sick at the time , my bilirubin was about 4 in the hospital. Since that time I have been plagued with chronic right upper quadrant pain that radiates around my right flank to my back, and nausea as well as diarrhea. The pain seems much worse after I eat. I have lost about thirty pounds.  I have seen a gastroenterologist, and have had an endoscopy (Bile gastritis only) colonoscopy which was normal, MRCP also normal, and a HIDA scan with some kind of SOD pictures that was also normal. All of my blood work has remained normal.  My GI is reluctant to proceed with an ERCP because of the negative HIDA and MR.  I See very Little about any kind of HIDA scanning in diagnose SOD, is this a valid tool, or is ERCP the gold standard??  I understand The procedure comes with the risk of parcreatitis, however I am starting to feel a little desperate.
Also, does a gall gladder that was chronically thickened on pathology help support the diagnosis of SOD?
Thank You
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The thickened gallbladder on pathology is a non-specific finding but does not necessarily correlate with SOD.

The ERCP with Sphincter of Oddi manometry would be the gold standard for diagnosis.  You are correct in that pancreatitis is one of the complications of this procedure.  

Another consideration would be a fatty meal ultrasound - where the common bile duct diameter is measured.  If there is an increase after fatty meal, then SOD is suspected and the manometry should be considered.  

These options can be discussed with your personal physician.

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.

Kevin, M.D.
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Hello Beth,

If you would please update us on how you're doing, I would really appreciate it. My mom is considering ERCP with manometry and possible Sphincterotomy. She's been putting it off for awhile for fears about it not helping, and even worse, that it could make her worse. At this point, however, she is pretty desperate for hope. She's had constant pain since having her gallbladder removed over a year ago. All tests show everything normal. Doctors feel it's SOD or maybe something just wrong way deep in her intestine, so a major exploratory type surgery, possible to remove part of the intestine, is the only thing they can think to offer anymore, besides the SOD possibility.

Anyway, please let us know if you had ERCP with manometry, what was found, what was done, etc. Thank you.

Adam
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Hello, sorry about your mom. I know the desperation she is feeling. I am a professional person and I was just about ready to quit my full time job because of the pain and nausea.  The update is that I did get a second Gastroenterology opinion at my Internists suggestion because the first was reluctant to do the ERCP without lab or other testing abnormalities.  The second opinion recommended the ERCP based on my clinical situation.  I did have a sphincterotomy and my nausea went away immediately.  My pain is much improved.  I did have mildly elevated bile duct pressures but pain during injecion of the bile duct during ERCP, which they considered diagnostic for SOD. overall I am much better.  The procedure is not much fun but its alot better than surgery!!!! with what I have learned, it sounds like this is a very reasonable step for your mom to have.  Its really not that bad.  I had a pancreatic stent placed to protect me from pancreatitis (the major risk of the procedure) which you usually pass on your own. From what you have said, and knowing what I've been through, I would encourage her to have it . good luck.  beth
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Beth G.

Thank you so, so much for your answer. Im giving this, as well as your other answer to me to my mom for some good moral support. I appreciate it very much. Im not sure if you're going to keep looking in this forum, if not, feel free to email me ***@**** or give me yours so I can check in with you again.

Thanks again,

Adam
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