Itching after total colectomy

I posted a question on 01/27/2006 under the name aljoby. I have had ten years of itching after total colectomy for U.C.
Recently the itching has been worse affecting my face. At the same time early this year there were symptoms of obstruction and delayed emptying. There have been intermittent small elevations of serum bilirubin. The itching varies and I can be clear for several days. It is definitely related to peristalsis and not food allergy. Recent LFTs are OK and on reducing food intake there is improvement.
I feel the problem is somehow related to low level intermittent subacute obstruction - probably at the anastomosis site.
On reviewing your archives I noted someone with virtually identical symptoms - a posting from e man on 09/21/2005.
I would like to know the outcome of his/her investigations to see if there are any similarities and possibly to compare notes by e mail. I understand they live in Alaska

This was the posting:

I've posted here before. I had my colon removed Feb 2004. I had a breif spike in my liver enzymes about 6 weeks after my colon was removed, and the enzymes went back to normal a few days after my loop ileostomy was connected to my j-pouch. My doctor theorizes that the elevated enzymes were a combination of iron anemia, dehydration and physical stress. I also had MRCP done at this time, which came out negative for any bilary obstruction or thinning of the ducts.

My current problem is generalized itching. My first outbreak was during the period where my liver enzymes spiked. It eventually subsided. About 7 months later, I had another terrible generalized itching attack. It lasted for a few weeks. My blood/liver stats were completely normal during this attack. I even had an MRI that showed nothing.

6 weeks ago, I had another terrible attack of generalized itching. It is still going strong. My current stats are:
Bilirubin 0.6, Alk Phos 52, AST 27, ALT 24. Everything else is also in range. My doctor cannot justify more MRCP/ERCP/Liver biopsy with stats this good. I've done massive amounts of research on PSC, and cannot find out whether it's possible to have generalized itching with completely normal LFT ranges. Also, I've seen Dermatoligists, and Allergists. There is no problem with my skin. This has got to be systematic. I realize that general itching can be a precurser to cancers and other diseases. I've been tested for everything that it could possibly be at this point. I want to know if this correlates with PSC. Here are my questions, and please feel free to elaborate on anything I've talked about.

Is generalized itching a sign that I may have PSC? (without any evidence in blood work, recent MRI, or MRCP)

If not, could it be something related to total colectomy? (I've only had these 3 itching episodes after colectomy).

Would you reccomend my liver be tested again?

If not, would you reccomend any other type of test?

Have you ever seen anything like this before? If so, please elaborate.

thanks,

eman

[Kevin Pho, MD]

I will contact the administration to see if you can contact eman.

Regarding the itching, one can certainly consider primary biliary cirrhosis.  Lab tests like ANA levels as well as antimitochondrial antibodies can be considered for further diagnosis.  If the results suggest PBC, a liver biopsy can be considered.  

If there is concern about a subacute obstruction, a CT scan can be considered to further evaluate this possibility.

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.
kevinmd_

[aljoby]

Thank you for your helpful comments.
I saw a specialist surgeon at the local hospital yesterday and told him of my thoughts. He feels that Primary Sclerosing Cholangitis is a possible complication of the total colectomy as he has found that itching in post colitis patients having a proctocolectomy is not uncommon.However he says it can run a chronic and fluctuating course without doing much damage which is reassuring. He doesn't seem to think the symptoms of obstruction - which coincidentally are much better now - account for the itching, but it is somehow related to the diease of IBD itself.
He is repeating my blood tests including CRP,LFTs and renal function tests,will do an Ultrasound of Gall bladder,a CT scan and a flexible sigmoidoscopic view of the pouch and anastomosis.
I am happy with this. I would like to contact e man to see what the outcome was there if possible.
Alanby