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Gastroenterology (Expert Forum)
13 Months After the Removal of Choledocal Cyst and Roux en Y, Still sick and in pain...
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
13 Months After the Removal of Choledocal Cyst and Roux en Y, Still sick and in pain...
by overcomingfaith, Mar 18, 2007 12:00AM
16 Months ago, I was admitted to hospital with sever pains in the abdonen. It was diagnosed that I had a recurring choledocal cyst and recurring colangitis. 12 months ago, the common bile duct was removed, however there were complications, and a completely new jejunal bypass and roux en y was preformed. (At age 8 months I had the same cyst & jejunal bypass, I am now 33 years old) Since then I have had severe pains in the abdomen(must take pain killers),serious exhaustion, mild fevers, NO jaundice. At present Bilirubin 24 ALT 140 AST 160, and GGT 527
Alkaline Phosphatase 630 There was a drop for about five months, June 06- Oct06, however they are slowly increasing once again to stated levels. Latest CT showed dialtion of the intra and extrahepatic ducts of the right frontal lobe, very swollen and dilated, could be stones, could be a blockage in the jejunal bypass. My MD, has refered me to a Gatro Spec, who has in turn refered me to another surgeon. I do not live in the same city as the original surgery took place, but could travel to that city for further opinions, or even a larger city.
My questions: There is a possibility that the surgeon will want to re-do the original surgery, could this create more problems, cancer, cirrosis, etc., for my future? (already had two of these done, 8 mons./32 yrs.).
Do you think I need to go to a very large acedemic hospital to have them look at it? (I live in a small city of 100,000)
Could I press for a living liver tranplant? (family member has offered a lobe of their liver)
I just don't want to live like this anymore....
Alkaline Phosphatase 630 There was a drop for about five months, June 06- Oct06, however they are slowly increasing once again to stated levels. Latest CT showed dialtion of the intra and extrahepatic ducts of the right frontal lobe, very swollen and dilated, could be stones, could be a blockage in the jejunal bypass. My MD, has refered me to a Gatro Spec, who has in turn refered me to another surgeon. I do not live in the same city as the original surgery took place, but could travel to that city for further opinions, or even a larger city.
My questions: There is a possibility that the surgeon will want to re-do the original surgery, could this create more problems, cancer, cirrosis, etc., for my future? (already had two of these done, 8 mons./32 yrs.).
Do you think I need to go to a very large acedemic hospital to have them look at it? (I live in a small city of 100,000)
Could I press for a living liver tranplant? (family member has offered a lobe of their liver)
I just don't want to live like this anymore....
Doctor's Answer
by Kevin Pho, MD, Mar 19, 2007 12:00AM
, Mar 19, 2007 12:00AM
I cannot comment on surgery recommendations without review of the chart.
There is a possibility that redoing the surgery may help with the symptoms. This would depend if there was a complication from the first surgery. Obtaining an MRCP can help image the biliary ducts.
With the symptoms mentioned, I would certainly consider an opinion by an academic medical center where more complicated cases are seen.
A liver biopsy can be considered if the ducts come out normal and the liver enzymes continue to elevate.
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_
There is a possibility that redoing the surgery may help with the symptoms. This would depend if there was a complication from the first surgery. Obtaining an MRCP can help image the biliary ducts.
With the symptoms mentioned, I would certainly consider an opinion by an academic medical center where more complicated cases are seen.
A liver biopsy can be considered if the ducts come out normal and the liver enzymes continue to elevate.
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_
Since 2 years, I have recurrent angiocholitis, abdominal pain, fever,...always treated by IV antibiotherapy. Yesterday, I made (for the second time) a percutaneous cholangiography (an invasive exam). Result : there seems to have a reflux in the reconstruction. I know angiocholitis is a complication of the surgery. But i am really afraid to have another surgery.
I think it is really important to be treat by an academic institution, because it is a rare disease...
I would like to have some advices, opinions,... have you meet these before?
Thanks for your help