Mystery Pain; Undiagnosed

I have had severe localized upper right quadrant pain for about two and a half years which worsens after eating.  My gallbaldder was removed in August of '03 and the pain has continued.  I have had CAT scans, ultrasounds, MRI, bowel series, upper and lower GI, ERCP, EGD, HIDA scan, and blood and urine work which all come back normal.  On the EGD they did discover that my stomach had not emptied completely after fasting since midnight.  I was diagnosed with a bile leak in an extra duct in April 2004 caused by the gallbladder surgery and they put a stint in and then removed it after a couple of weeks.  I received some relief from that, but the pain continues and now they are saying that there is no more leakage or blockage, no extra stones or sludge.  Everything is coming back ok.  Any suggestions on what it could be?  

[Kevin Pho, MD]

One consideration would be Sphincter of Oddi dysfunction - where the symptoms can worsen after gallbladder removal.  To diagnose this, an ERCP with Sphincter of Oddi manometry would be the best test.  You have stated that an ERCP has already been done - you did not mention whether manometry was also completed.

If that is negative, certainly things like irritable bowel syndrome as well as gastroparesis can be considered.  A gastric emptying scan can be considered to evaluate for the latter disease.  

You may want to discuss these options 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.
Medical Weblog:
kevinmd_b

[lucieduce]

I forgot to mention that I am a female in my early forties.  Thank you.