Re: Choledochocele

Posted By Amei on October 08, 1998 at 20:52:38:

In Reply to: Choledochocele posted by James on October 06, 1998 at 15:53:23:






I have written in before and have appreciated your excellent knowledge.  I have been complaining a lot lately about strong spasm pain just below the sternum.  This was especially prevelant early in the morning upon wakening.  I just had a detailed meeting with my G. I. Doc with the following results.  He reviewed with me the results of a upper GI CT scan a year ago which indicated a slightly irregular and thickened area of bowel adjacent to the ampulla.  Also the following was the results of a Cholangiogram that was done at the time of my LAP chole 3 months ago that revealed chronic inflammation without stones.  " There is a somewhat unusual collection of contrast at the ampulla with a somewhat rounded configuration.  Although this might represent an unusual recess of the duodenum, a choledochocele, which is a type of choledochal cyst, cannot be excluded, and clinical correlation is recommended.  In addition, there is contrast filling of an apparent bowel loop in the expected location of the proximal duodenum which has an unusual appearance in that its communication with the transverse duodenum distal to the ampulla is norrowed and irregular on both of these images; although this might represent a duodenum deformed by peristalis, a large diverticulum cannot be excluded.  Possible limited sclerosing cholangitis involving the ampulla also cannot be excluded in the region of the irregularity and possible choledochal syst."  As a note of reference, I have had some sort of spasm type of pain in the midepigastric area since I was in my late teens.  ( I am now 45 ) This spasm discomfort has waxed and waned for years but in the last 3-4 years has become more frequent.  And it has become more acute since the removal of the gallbladder, even though the right epigastric pain has disappeared.  My G.I. Doc wants to schedule an ERCP within the next few weeks.  He thinks it is a duct problem, not a pancreas problem. ( I don't drink, CT scan normal a year ago ).  He says he will be looking for any possible stones or cysts in the area as well as any abnormal type of congenital duct formation.  My question is why do we need to do this when we did the Choleangiogram which would show abnormalities in the duct?  Also, I have heard that the odds are good that ERCP can lead to an Acute Pancreatic attack or even death??  Your adivice on this is appreciated.  I find myself very apprehensive about where this is going.  ( As a side note, he wants to do a PH monitoring to see what is going on with my mild grastritis which is controlled by Prevacid and depending upon those results may recommend a LAP Nisan.) Many thanks!!    
Hi.  Question for you - would you please detail your current symptoms for me?  I have been having pain in the center, just below the sternum for about a year.  There is an associated pain under the right shoulder blade that is almost always present when the abdominal pain is at it's worst.  Sometimes the back pain appears alone.  These symptoms are minor when I wake up and steadily increase over the next 30 min or so then gradually taper off.  Tagamet or Pepcid seems to help both.  My dr says it's gall bladder, but you've already had yours removed.  I'm trying to gather info from others who have similar symptoms so I can persuade the dr to look further (he's under pressure from an HMO who doesn't want to do more tests until I have the gall bladder removed).  
I have recently begun taking acidophulus and a digestive enzyme capsule that I get from the health food store as well as physillium (sp?) several times a week.  It seems to be helping and my symptoms are lessening but there are several other factors that could be responsible.  
I hope the dr here has some encouraging words for you.  Good luck.