post operative pain

  My husband, 47, began having constant, cramping abdominal pain in late May.  He had a complete GI workup ending with a HIDA scan diagnositc of dyskenesia (16% ejection fraction).  He had lap chole on July 10.  He is now 4 1/2  weeks post op and continues to have the same cramping abdominal pain, although it is no longer constant.  He is using charcoal and Levsin, and when these don't work, he uses Percocet.  He is disheartened that the pain is not improved.  The pain does not seem related to any particular food.  The gastroenterologist offers only a small bowel follow through to complete the workup. The surgeon says he had a good look through the scope  at the small bowel, liver and pancreas and all looked normal.  How long can we expect to pain to continue?  Are there other possible causes to be considered?  Can anyone suggest further workup?
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Dear Jeanne Liken,
There have been many letters to the Forum describing persistent pain after gall bladder removal.  The success of this surgery is greatest if patients have classical symptoms of biliary colic (right upper abdominal pain starting approx 30-45 min after eating.  Pain increases in a step-wise fashion over 60 min and then gradually subsides)or acute cholecystitis.  In other words, the presence of gall stones does not necessarily mean that the stones are the cause of the pain.
It is necessary to have additional information regarding the pain.  Where was the pain most severe?  What factors made the pain better?worse? Has the pain been associated with weight loss, fever, loss of appetitie, change in energy?  What tests have been done?  If your husband has had evaluations of stomach, small intestine and colon that were normal, then it is conceivable that his problem is due to irritable bowel syndrome.  Finally, it is possible that the pain is related to the surgery and will gradually subside spontaneously.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: abdominal pain, gall bladder surgery, irritable bowwel syndrome
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