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Gastroenterology (Expert Forum)
Follow-up to duodenal perforation secondary to ERCP / Gallstones
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.
Follow-up to duodenal perforation secondary to ERCP / Gallstones
by 21 Staples, Feb 29, 2004 12:00AM
Questions:
I can't get a straight answer about what follow-up procedures need to be performed after gallstones, pancreatitis, common bile duct and duodenum perforation secondary to an ERCP? The VA is not returning my calls and my abdominal pain has been steadily increasing for the last several days. Also, what are the long-term complications of the perforations and pancreatitis? Are adhesions the only concern? Are there any other ones that are possible?
Background:
I underwent an ERCP (1/28) a month after passing a gallstone (12/25). The stone caused pancreatitis with lipid counts approaching 11k. My doctor encouraged me to have my gallbladder out as soon as possible. He commented that a second gallstone and the resulting pancreatitis could be fatal. (Is this true?)
I underwent the ERCP and when I regained consciousness in recovery, the nurse was trying to get me to stop screaming. All I could say was, "why am I in so much pain?” The doctor who performed the ERCP told my wife was told that there were no complications during the ERCP and that a stent was placed in my common bile duct. I don't remember much of the recovery room expect vomiting bright green bile often and being in tremendous pain. The doctors, however, would not give me pain medicine. The pain was incredible; it didn't even begin to compare with that of my gallstone, which up to that point was the worst pain I had ever experienced. The doctors ordered a CT scan and x-ray, but didn't see any perforations. When they rolled me from side to side for these procedures, the pain spread quickly and intensely to other areas of my abdomen. I stayed in this condition for approximately 10 hours without pain reducing medicine. By this time I was in the ICU and the surgeon reluctantly decided to perform exploratory surgery. They found a perforation in the common bile duct and in my duodenum. They left my gall bladder, due to the amount of bile and other fluids (what are those other fluids?) that were present in my abdomen.
I went in to have my staples removed a few weeks ago and asked the VA doctor to tell me what follow-up needed to occur. He promised to get back to me, but now I can't get any answers from the VA or the doctor. The medical records I received seem very inconsistent with what the doctors told us. (i.e. records say I have a stent, the GI doc says no.) Why would the VA tell us one thing and then document it differently in the records?
Current Concerns:
My abdominal pain has increased over the last two days, but the VA will not respond. What should I do? Do I need my gallbladder out? Should I just continue my low-fat diet indefinitely? Your advice / response would be greatly appreciated!
I can't get a straight answer about what follow-up procedures need to be performed after gallstones, pancreatitis, common bile duct and duodenum perforation secondary to an ERCP? The VA is not returning my calls and my abdominal pain has been steadily increasing for the last several days. Also, what are the long-term complications of the perforations and pancreatitis? Are adhesions the only concern? Are there any other ones that are possible?
Background:
I underwent an ERCP (1/28) a month after passing a gallstone (12/25). The stone caused pancreatitis with lipid counts approaching 11k. My doctor encouraged me to have my gallbladder out as soon as possible. He commented that a second gallstone and the resulting pancreatitis could be fatal. (Is this true?)
I underwent the ERCP and when I regained consciousness in recovery, the nurse was trying to get me to stop screaming. All I could say was, "why am I in so much pain?” The doctor who performed the ERCP told my wife was told that there were no complications during the ERCP and that a stent was placed in my common bile duct. I don't remember much of the recovery room expect vomiting bright green bile often and being in tremendous pain. The doctors, however, would not give me pain medicine. The pain was incredible; it didn't even begin to compare with that of my gallstone, which up to that point was the worst pain I had ever experienced. The doctors ordered a CT scan and x-ray, but didn't see any perforations. When they rolled me from side to side for these procedures, the pain spread quickly and intensely to other areas of my abdomen. I stayed in this condition for approximately 10 hours without pain reducing medicine. By this time I was in the ICU and the surgeon reluctantly decided to perform exploratory surgery. They found a perforation in the common bile duct and in my duodenum. They left my gall bladder, due to the amount of bile and other fluids (what are those other fluids?) that were present in my abdomen.
I went in to have my staples removed a few weeks ago and asked the VA doctor to tell me what follow-up needed to occur. He promised to get back to me, but now I can't get any answers from the VA or the doctor. The medical records I received seem very inconsistent with what the doctors told us. (i.e. records say I have a stent, the GI doc says no.) Why would the VA tell us one thing and then document it differently in the records?
Current Concerns:
My abdominal pain has increased over the last two days, but the VA will not respond. What should I do? Do I need my gallbladder out? Should I just continue my low-fat diet indefinitely? Your advice / response would be greatly appreciated!
Doctor's Answer
by Kevin Pho, MD, Mar 03, 2004 12:00AM
, Mar 03, 2004 12:00AM
Certainly another opinion is needed if your current group of physicians are not giving satisfactory answers.
A repeat ultrasound would be a reasonable next test to evaluate whether there continues to be bile duct leakage. Depending on whether there is damage, a repeat ERCP or percutaneous transhepatic cholangiography (PTC) can be considered. Leaks can be repaited via stenting during the ERCP.
In any case, I would suggest another surgical or GI opinion to evaluate your symptoms.
I cannot answer whether you need your gallbladder to come out, or how long you need to continue your low-fat diet without being personally involved in your case.
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.
Thanks,
Kevin, M.D.
A repeat ultrasound would be a reasonable next test to evaluate whether there continues to be bile duct leakage. Depending on whether there is damage, a repeat ERCP or percutaneous transhepatic cholangiography (PTC) can be considered. Leaks can be repaited via stenting during the ERCP.
In any case, I would suggest another surgical or GI opinion to evaluate your symptoms.
I cannot answer whether you need your gallbladder to come out, or how long you need to continue your low-fat diet without being personally involved in your case.
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.
Thanks,
Kevin, M.D.
