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Gastroenterology (Expert Forum)
Complications after surgery
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.
Complications after surgery
by tinawildtree, Feb 17, 2006 12:00AM
I'm trying to help a friend. She has spent the last 5 months, plus acquired many medical bills in trying to get help. (she has no health insurance) June 1, 2005 had Laparoscopic surgery which was then converted to an open cholecystectomy with cholangiogram common bile duct exploration & 14 French T-Tube placement. On 6/14, clamped off the T-Tube. 6/23 no bile drainage from JP, so was removed. 7/15 Started Actigall 300 mg to try to help maintain bile flow (was having "fullness" in upper quadrant) The Actigall didn't work. 9/7 Had a T-tube cholangiorgram with dilation of the Ampulla. Had NO SWELLING OR FLUID BUILD UP for 42 hours after the tube was removed. Ever since this date (9/9) she has been trying to find out what is causing her condition. Her bowel movements are fine. She looks to be about 7 months pregnant retaining fluid in her body EXCEPT for her chest area. From her belly button down it is "soft", but from there up it is "hard". She measures her stomach each day (top & bottom) and her measurements are about 1 to 2 inches lower in the morning than evening. She gets some relief in the morning, but as the day goes on she gets worse. She describes her "misery" as feeling like her skin is "stretched to the max" and sometimes she has trouble breathing. Her stomach is very sensitive (above belly button)to where she can't have anything restricting it. It doesn't seem to matter what she does or does not eat...she still gets this way.
Here are the tests done so far and the medications she has tried for various things:
TESTS: CT scan of abdomen & pelvis, Colonoscopy, MRI, MRI with contrast, Upper GI endoscopy with biopsies, Chest X-Rays Front AL/LAT, Gastric Emptying test, Ultra sound on pelvis, Lots of Blood work (also for cancer of ovaries)(liver enzyme:AST(SGOT 44, Gluccse 112) All tests show nothing. She mentioned to one doctor about the test for Spinchter of Oddity, but he said she would be in alot of pain if she had this, so he did not do one.
MEDICATIONS TRIED: Ursodiol 300 mg, Sucralfate 1gm, Cholestyr, Aciphex 20 mg, Pamine Forte Tab 5mg, Amitriptyline 10 mg.
She has told all of the doctors that she has seen...when the T-Tube was in, she was normal! But now she is miserable! They said that the MRI with contrast would show if she had any blockage, and it showed none. She is getting more and more depressed with not getting any answers and with all of the medical bills adding up. Of course, they say, just send $20 month, well when you have to send that to 20 different places and your family income is less than $20,000 per year, you really feel like you are doomed! She said she would rather live with that drainage tube the rest of her life than feeling miserable! I sure hope you have some idea of what her problem might be, before something serious happens to her. It seems like when someone doesn't have insurance, it takes alot longer to get appointments!!
Here are the tests done so far and the medications she has tried for various things:
TESTS: CT scan of abdomen & pelvis, Colonoscopy, MRI, MRI with contrast, Upper GI endoscopy with biopsies, Chest X-Rays Front AL/LAT, Gastric Emptying test, Ultra sound on pelvis, Lots of Blood work (also for cancer of ovaries)(liver enzyme:AST(SGOT 44, Gluccse 112) All tests show nothing. She mentioned to one doctor about the test for Spinchter of Oddity, but he said she would be in alot of pain if she had this, so he did not do one.
MEDICATIONS TRIED: Ursodiol 300 mg, Sucralfate 1gm, Cholestyr, Aciphex 20 mg, Pamine Forte Tab 5mg, Amitriptyline 10 mg.
She has told all of the doctors that she has seen...when the T-Tube was in, she was normal! But now she is miserable! They said that the MRI with contrast would show if she had any blockage, and it showed none. She is getting more and more depressed with not getting any answers and with all of the medical bills adding up. Of course, they say, just send $20 month, well when you have to send that to 20 different places and your family income is less than $20,000 per year, you really feel like you are doomed! She said she would rather live with that drainage tube the rest of her life than feeling miserable! I sure hope you have some idea of what her problem might be, before something serious happens to her. It seems like when someone doesn't have insurance, it takes alot longer to get appointments!!
Doctor's Answer
by Kevin Pho, MD, Feb 18, 2006 12:00AM
, Feb 18, 2006 12:00AM
There has certainly been a pretty comprehensive evaluation done. I would consider evaluating the biliary tree, and for Sphincter of Oddi dysfunction. This can sometimes cause gallbladder pain in those who had their gallbladders removed.
An MRCP would be an imaging study to evaluate the biliary tree via MRI. The ERCP is the more definitive test - and can be combined with Sphincter of Oddi manometry to evaluate for dysfunction.
You can discuss this test with your personal physician, or in conjunction with another GI consultation.
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_b
An MRCP would be an imaging study to evaluate the biliary tree via MRI. The ERCP is the more definitive test - and can be combined with Sphincter of Oddi manometry to evaluate for dysfunction.
You can discuss this test with your personal physician, or in conjunction with another GI consultation.
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_b
Member Comments
by bloat41, Feb 19, 2006 12:00AM
Hi! I am having the same problems your friend is having. I went for a CT scan on Friday. Can you tell me if your friend has found any answers to her questions. I am truly tired of feeling this way. I had surgery 3 weeks ago. The doctor looks at me as if I am crazy. He stated that this is not normal after gallbladder surgery, but he feels it stems from some underlying reason. My problem is that I did'nt have these problems prior to surgery. I only found I had biliary dykensia because of upper right quadrant pain.
