Pancreas/Gallbladder

Hi there .I am a 34 year old white 182 lb male. I have been ill since 2006 with right & left front rib pain also right & left side pain & pain in my mid back all the way around..I have had one small elevation of amylase(137) in 2006 & have had consistent elevations of lipase~(320) of & on up to now. I have been diagnosed with Hemochromatosis since 1995 & have maintaned a ferritin below 20 since 1995 & have been told that this is not from Hemochromatosis. I had Neg MRCPS & a negative ERCP in 2006.Also Neg Egd,. Recent neg Abd CAT scan., Neg colonoscopy .,Neg small bowel.Neg US of abdomen (with exception of small Gb polyp near the neck). Recenty the pain has become more severe in my front ribs & on each side right & left & in my back when I eat anytime up to 2 hrs after.I have been managing this with a low fat diet since 2006 but it now has become 'intolerable'.
My doctor ran a Hida scan & it said ;Normal uptake through the Liver
                                                     Prompt uptake In the Gb
                                                     Gb ejection fract is 18%
                         Impression;Suggestive of sphincter of oddi dysfunction or Chronic cholecystitis

I am concerned about which way to go from here doctor & welcome suggestions on which avenue to take..

My Last ERCP was in 2006 & was normal so was MRCP in 2006. Should I have another one of either or maybe an even an EUS to see if anything has changed since  2006 before I do anything else?

Or maybe I should proceed staight to the surgeon to have the GB removed?

Can this low ejection fraction of 18% of the Gallbladder on the Hida scan along  with a normal ultrasound of the abdomen( with an exception of a small polyp near the neck of the Gb) cause pancreatitis and/or  my symptoms.
I dont want to have unnessasry surgery ,But if I need it, I want it.
                
                                        

                                                    

[Kevin Pho, MD]

You have had a very comprehensive evaluation thus far, which would exclude many of the major GI causes.

A low gallbladder ejection fraction may be responsible for the symptoms.  There are small studies that suggest removing the gallbladder may help with the symptoms.

If Sphincter of Oddi dysfunction is the diagnosis, treatment can include surgery, a sphincterotomy, or Botox injections into the Sphincter.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[davemc]

Just curious -- is your rib, side, and back pain continuous or is it an event that has a start and stop?  I have similar pain that was not relieved by GB surgery.  The pain starts in mid-back, then starts up in abdomen below ribs.  This whole pain event typically runs 30-45 min. then the pain goes away like someone turned off a valve.  But there is lingering minor pain/soreness for hours, almost like I was having cramps.

[lionheart42008]

Hi Bryant-  I'm not a doctor, but I have been through everything you've been through.  I had an ERCP and it showed my sphincter of oddi dysfunction.  Mine was almost completely scarred closed, they opened it back up and used a balloon to open it further.  Please be aware that of course if it's needed, it's needed, but I ended up with SEVERE pancreatitis- both my amylase and lipase were over 2000- that happened within 24 hrs of my procedure.  I was 25 at the time- and I ended up in ICU for 4 days.  I also had a HIDA scan done- my ejection fraction was only 2%- so my gallbladder had to come out as my liver functions were out of this world. Having your gallbladder is still surgery.  there are complications that can arise from it, namely IBS.  Without your gallbaldder to regulate bile flow into your small intestine, a lot of patients end up with a very low fat diet, just so they don't end up stimulating bile production and ending up with horrible painful, mucosy, awful stools.  I know- I still live that everyday.  It has been almost 10 yrs post surgery for me and I still have problems. I had the ERCP to help diagnose my condition.  Have your docs run and autoantibody tests (ANA,ASMA?)?  I was diagnosed with AutoImmune Cholangitis in 1999.  ERCP is used pretty regularly to help diagnose Biliary Tract problems, but you might check with your doc and tell him/her you're concerned and ask if they ever checked you for Auto Antibodies-- Ercp is pretty sensitive- they check out the Oddi-- but please go do some research and talk with a doctor you trust, a good one will listen to you and not make you feel crazy.  Good Luck and I wish you all the best!

[helper11]

cck stimulation?? did tht cause pain? .... hav the doctors considered spine problem ??