Gallbladder pain (?) without a gall bladder

[jonnee]

10 days ago I made a trip to the emergency room with pain in the upper right quadrant.  The pain was very reminiscent of the pain I had experienced before having my gallbladder removed.  After taking blood tests and giving me a "cocktail" to drink they sent me home saying it was acute gastritis.

Prior to the "attack" I had dieted rather strenuously for about a week and then celebrated Mother's Day with a pretty rich meal at an Italian buffet.

I continue to have some dull pain and tenderness in the area.  Today, I visited with the physician's assistant and she didn't seem too concerned, she referred to the results of the lab taken in the emergency room.

In November 2002 I was hospitalized with a bleeding ulcer.  I had been taking Aleve and aspirin and a few doses of Vioxx for an "arthritic" leg.

Around the 18th or 19th of April, this year, I had started taking Vioxx for more "arthritic" pain after talking with the same physician's assitant.  But I had stopped after about a week because my blood pressure seemed to be on the rise.

Could there be any correlation?  Also, I surely would appreciate and ideas and advice on what might be going on and if there is anything I can do to stop the "gripe". Thanks!

[Kevin Pho, MD]

Considerations would be Sphincter of Oddi dysfunction - which can manifest in those without a gallbladder.  Another possibility would be bile duct stones.  

To test for SOD, a fatty meal ultrasound can be performed, and if positive, then an ERCP with Sphincter of Oddi manometry would be the definitive test.

To evaluate for biliary duct stones, an MRCP or ERCP can be considered.

Regarding the Vioxx, although there should be less GI side effects, there are small cases where ulcers and inflammation are possible.  If this is suspected, an upper endoscopy can be considered.  

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.
Medical Weblog:
kevinmd_b

[ratbag]

My father had severe pain in the same place - 20 years after his gallbladder was removed. His GP refused to believe it could be gallstones because there was no gallbladder. An ultrasound did not reveal any stones.
But he had huge stones blocking his common bile duct which were removed by ERCP.
I also had biliary stones, but I still have my gallbladder. It took me 14 months to convince doctors that I had biliary colic and not IBS cramps.
My first ultrasound a year ago revealed no stones, the ultrasound this month revealed "2 or 3" stones - there were 8 huge ones blocking my bile duct. The largest was 1.3cm diameter and 2.2cm long. So ultrasounds are not very accurate IMHO.
There is no other pain like biliary colic. It is so severe, those who haven't had it just seem to think you are exaggerating. Don't take no for an answer - demand further tests. Good luck.

[ratbag]

ps
Also - in blood tests - my bilirubin was normal and I was not jaundiced, so that was another reason it was hard to believe I had stones in the bile duct.

[krisg]

besides biliary stones, SOD (sphincter of oddi dysfunction) is also noted to be a common cause of biliary colic after gallbladder surgery.  I am one of those "lucky ones" who have it.

[Katatonic]

For all of you who have had your gallbladder removed and continue to have problems---Let me tell you my story.  I had my gallbladder taken out in May 2000. I was 25 at the time.  Immediately after the surgery I STILL didnt feel better.  They kept telling me it would take time for my system to level out.  By July I was STILL in pain with constant diarreah and throwing up.  The pain on my right side continued.  But worse there was new pain.  My intestines seemed to hurt....I was sick all the time....fevers etc.  I never seemed to get better.  I was sent by the surgeon to see a gastro doc.  He ran GI tests, etc , etc and pronounced it as IBS.  I took Levisin, amitryptilene etc to control the BMovements to no avail.  Still I got sicker.  A year passed and in 2001 I went BACK to the gastro---he did ALL the tests again...still nothing showed.  Still I was running fevers etc.  He decided it was spastic colon.....more meds to no results.  In Jan 2002 I was ready to die....I had lost weight...and was getting sicker and sicker.  The doctor told me there was NOTHING he could do about it...that it was just a spastic colon and Id have to live with it.  So much for compassion and understanding huh?
Fed up with it I went to my OBGYN and said to him...I dont know what is wrong...I keep running these fevers...i am still throwing up...in pain...and the gastro doc keeps saying its spastic colon.  But if someone doesnt do something soon I am going to die.  
He decided to monitor me for a couple of months...which I agreed to.  I kept getting sick.  So in June of 2002 he did an exploritory laproscopy.
Here is the boo hiss part guys----the surgeon had botched the surgery.  when someone does a laproscopic proceedure---mistakes are made more often than you know.  My omentum (that layer of fatty tissue over your organs) had been pulled away to get to my gallbladder.....welll...it wasnt put back in place.  
It wrapped up around my intestines and my ovary and then pushed it all into my right hip and attached there.  
The OBGYN undid all the damage and closed me back up.
The DAY OF THE SURGERY even with stitches etc I felt better than I had in three years!!!  The incredible weird bulge under my ribcage was gone.  NO MORE DIARREAH!
The really boo hiss part of this is that I have no avenue to do anything to get compensation from the doctor who did the original surgery.  2 year malpractice limitations....no one wants the case.  Why?  because all the docs and lawyers are buddies.  
Recently I was in pain again....could have sworn it was my gallbladder...you know what it was...KIDNEY STONES.  So those are two options that people miss.
If your omentum is out of place they cant see it it with a scan....they have to open you up to see it.  
Kidney stones can be seen with an xray or scan...but they have to THINK about it.  so mention that too!  NO CONTRAST DYES either if they run tests....then they CANT see em.

Thanks!