Just trying to find some answers

[Liz04]

I have quite a history of stomach problems.  I will explain them as briefly as possible before I ask my question.  I had my gallbladder removed in 1998 via laparoscopic surgery. There were no stones, but it was only functioning at 11%.  My symptoms did not improve a whole lot after that, if fact, over time they got worse. I felt bloated after I ate and began vomiting. An endoscopy was done and they found I had a growth that was obstructing the outlet of my stomach.  They removed about a third of my stomach and the pyloric sphincter and rerouted the outlet.  Now I have frequent diarrhea (dumping syndrome), low blood sugars, bile reflux and frequent bouts with gastritis.
I have pain under my ribs on my right side, it tends to get worse after I eat.  In the last 18 months I have had two very painful episodes that i would consider a 10+++.  I got this terrible cramping pain in my right side that would radiate through my back and chest.  I ended up in the hospital both times. I also have very bright yellow stools.  Not all the time, but at least once a day.
After my first episode I went to a specialist.  By the time I got in to see him, I was feeling much better. He wanted to do an ERCP and explained that bile ducts can still get plugged for various reason. He also stated that with my altered anatomy it may be difficult to find the ducts.  I was feeling fine so I opted not tohave it done.
After the 2nd episode I went to the Mayo Clinic.  I waited awhile for the appt. and by the time I got there I was feeling fine.  They found nothing besides the dumping syndrome, gastritis and bile reflux.  I was also very anemic.  They diagnosed me with Chronic abdominal pain, which I think means they have no idea.
Throughout all of this, I have done some research on my own.  A friend of mine suggested biliary colic.  The symptoms I have match this, but to my knowledge I have never been jaundice. Could it be possible to have biliary colic without being jaundice?  Would it be worth the risk to have an ERCP done?  Are there any other test they can do to find out? What are your opinions as to what this could be and could you think of any other tests that should be done? Right now my life is being controlled by my GI problems.  I really want a solution.

[Kevin Pho, MD]

Similar to the question below, I would again consider Sphincter of Oddi dysfunction - which tends to cause biliary-type pain in those who have had their gallbladders removed.  One option would be to proceed straight to ERCP with Sphincter of Oddi manometry (which is the gold-standard for this diagnosis).  Another option would be to consider fatty-meal ultrasoundography which can suggest this diagnosis.  

It may be possible to have biliary colic without jaundice.  Another test to consider that would be less invasive would be an MRCP, however this test cannot be combined with the Sphincter of Oddi manometry.  

Bright yellow stools are suggestive of biliary blockage - I would suggest discussing either the ERCP or MRCP as the next test.  

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:
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