Pain after Gallbladder Removal

[Suffering after Gallbladder removal]

I have been suffering for 2 years.  I had my gallbladder removed
and the pain returned 2 months to the day.  I have had MRI, Endoscope, ERCP, Cat Scan, Ultra Sound.  I went to a pain management clinic and an Osteopath and even tried Acupunture

I've seen the top Gastro Doc at MGH in Boston and no one can diagnose what is wrong with me.  They left me with only one choice exploratory surgery.

Can someone email me what test they can do which will show
what this is.  It's like they never took the damm thing out.

I am reaching the end of the line.  I can't take it anymore.

I haven't slept well for 2 years.  2-4 hr  a day.

I stopped taking all the pain medicine they gave me because it
was just masking the systoms that something is really wrong.

If anyone knows a good doctor in the Boston area that can help me
please email it back to me.

The pain stays in one place right hand side just under the rib cage ( where my gallbladder used to be )

HELP ME
thanks

[nadia]

I have had the same thing happen to me, except that my pain never stopped even after the gallbladder was removed. It radiates into the chest and back area and is quite disabling.  I have to wait 6 months to see a specialist because of backlog.  My problem is that I have no other symptoms except pain, and the doctors don't take it very seriously. I want more testing done and don't really know what else to ask for since I have had just about everything done.  I truly believe the pain I have is something pre-existing to the gallbladder condition. My doctor thinks it may be sphincter of oddi dysfunction, but I was told by the person who did the Hida scan that it would have shown up there. So I am at a loss as well.  If you have any luck with your surgery please let us know.  Good luck!

[Nanny]

Sphincter of Oddi usually can be determined with an ERCP with monometry, have you had this done?  I don't know whether it will accurately show with a HIDA scan.  If you think this may be your problem, I've pasted some information about this below.  You may have developed pancreatitis as a result of the SOD.

Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction and papillary stenosis are conditions which occur when this sphincter (opening) mechanism is disturbed. When the hole is too tight, there is a backup of bile and pancreatic juices. This can cause pain (biliary colic). More prolonged obstruction may result in bile leaking back into the blood stream, resulting in abnormalities of the liver function tests, or even yellow jaundice (discoloration of the eyes and skin). Also, blockage to the pancreatic orifice can cause pancreatic pain or attacks of pancreatitis.

Papillary Stenosis can be caused by passage of stones, or scarring after treatments (e.g. endoscopic or surgical sphincterotomy). Papillary stenosis usually results in sufficient backup of bile flow that there is stretching (dilatation) of the bile duct. This can be recognized by scans and various x-rays, including ERCP. Papillary stenosis requires endoscopic or surgical treatment. The hole is enlarged by cutting, to improve drainage. Occasionally it is necessary to do a surgical bypass (choledochoduodenostomy, or Roux-en-Y hepaticojejunostomy) to insure that drainage is effective.

Spasm of the Sphincter

This is a more difficult problem. It may be one  manifestation of other muscular spasm problems in different areas of the body (such as the esophagus or intestine--irritable bowel syndrome). However, in some patients, it is the prevailing complaint, and requires focal attention. The pain symptoms are very similar to those caused by bile duct or gallbladder stones. Indeed, sphincter of Oddi dysfunction most frequently occurs in patients who have previously undergone removal of the gallbladder (cholecystectomy). Some patients present with unexplained attacks of acute pancreatitis when the pancreatic sphincter is involved predominantly.

Diagnosis of sphincter of Oddi Dysfunction

Initially, tests are aimed to make sure that there are no stones present. Standard ultrasound and CT scans are not very accurate in detecting or excluding bile duct stones; newer techniques such as MRCP and endoscopic ultrasound are more sensitive, but not yet widely available. Most patients are investigated with ERCP. The doctor can examine the drainage hole of the bile duct at the papilla of Vater, and inject dye into the bile duct and pancreatic duct to look for stones and other forms of obstruction. The possibility of sphincter spasm (dysfunction) is considered only when these other conditions have been excluded. Dysfunction can be recognized by a special technique during ERCP, called sphincter of Oddi manometry (SOM). This involves passing a small catheter (tube) into the bile duct and pancreatic duct, to measure the squeeze pressure.

[Bluitt]

I would like to thank you for sharing what you are going through reguarding you gallbladder, because I am going throught the same thing at this time.

I have have my gallbladder removed one year and three months now but the pain only stopped a little while.  At first I thought this was a sever case of gas and that I could have been going crazy because my gallbladder was gone.  The pain has gotten so bad that I've have to vist the ER several time this year, there hasn't been anything such as pain medication or any other type of medication that has helped with my pain at all.  Now my doctor is dicussing surgery again and to tell you the truth I am very scared.  I am only 26 years old and I've never had any kind of medical problems until now and I didn't know weather or not another surgery was a good idea.  I've had every test there is for me to take and all of them have come back normal.  Right now I'm at the point of frustration and I'm willing to try what every it take to stop the pain and get my life back.

                                        

                                               Please Help,

                                               Bluitt

[Lor]

I have been diagnosed with Sphincter of Oddi dysfunction. Like countless others I went through many tests and saw many Drs trying to find an answer to my pain. It was horrible pain that I wound wish for anyone. I spend almost every night for a year and a half sleeping sitting up in a chair. There were times when the pain was so bad I would force myself to throw up just for relief of the pain. It lasted 20 minutes or so - then come right back. I finally was refered to the borland groover clinic in Jacksonville Florida to have an ERCP with menometry done. The pressure in my bile duct was way up and had the sphincterotomy done. What a relief!!! I did get pancreatitis which I think was a small price to pay to get rid of the pain. Now 6 months later my pancreas is acting up and will probably have to go in and have the other ducts looked at. They don't like to go in too far, because of the risk involved, but its clear they need to now. Anyone who is experiencing such pain after gallbladder should never give up on getting the right diagnoses. It is terrible to go to Drs for help only to come out with the diagnoses of IBS which is so way off from this pain.

[nadia]

Thank you very much for your suggestions.  I did suspect pancreatitis because the pain symptoms were similar, however, I don't seem to have all the other symptoms that come with it. I am going to investigate this further on Wednesday.
Is malabsorption always a symptom of this disorder?  Thanks again for your reply.

[Nanny]

Malabsorption is usually only a problem with chronic pancreatitis, but not acute pancreatitis.  Even then, not all chronic patients have this problem.  The symptoms of chronic pancreatitis are pasted below.  Some people have all the symptoms, some people just a few, each case is different, and that's why it is such a difficult condition to diagnose.

[Nanny]

Here's those symptoms I mentioned.

What are the symptoms of chronic pancreatitis?

The symptoms are very variable.

Pain occurs in most patients at some stage of the disease. This may vary in intensity from mild to severe. It may last for hours or sometimes days at a time and may require strong painkillers to control it. It often radiates through to the back and can sometimes be relieved by crouching forward. It is commonly brought on by food consumption and so patients may be afraid to eat. It is also commonly severe through the night. The pain varies in nature, being gnawing, stabbing, aching or burning, but it tends to be constant and not to come and go in waves. It may sometimes burn itself out but can remain an ongoing problem.

The mechanism of the pain is unclear. It seems to be related to pancreatic activity since it is frequently caused by food, especially fatty or rich foods. Some patients will have obstruction to the small ducts in the pancreas by small stones, and this is thought to cause back pressure and destruction of the pancreas. There is no relationship between the severity of the pain and the severity of the pancreatic inflammation.

The pain is often difficult to diagnose and can be mistaken for pain caused by virtually any other condition arising from the abdomen or lower chest.

It can be difficult to distinguish pain caused by pancreatitis from pain caused by a peptic ulcer, irritable bowel syndrome, angina pectoris, gallstones.

Diabetes is also a common symptom which affects over half of all patients with long-standing chronic pancreatitis. Long-standing chronic inflammation results in scarring of the pancreas which destroys the specialised areas of the pancreas which produce insulin. Deficiency of insulin results in diabetes. Diabetes causes thirst, frequent urination and weight loss. It may be possible in the early stages of chronic pancreatitis to treat the diabetes with tablets, but in the late stage of chronic pancreatitis, insulin injections are usually needed.

Diarrhoea occurs in just under half of patients. Normally, all the fat in food is broken down by enzymes from the pancreas and small intestine, and the fat is then absorbed in the small bowel. With a reduced level of digestive enzymes the fat is not absorbed. When the fat reaches the large intestine, it is partially broken down by the bacteria in the colon. This produces substances which irritate the colon and result in diarrhoea. The undigested fat also traps water in the faeces, resulting in pale, bulky, greasy stools which are difficult to flush away. They may make the water in the toilet look oily, smell offensive and be associated with bad wind.

Weight loss occurs in virtually all patients with chronic pancreatitis. It is due to failure to absorb calories from food and diabetes may also contribute to this. In addition, patients may be afraid to eat because eating brings on the pain. Depression is also common in chronic pancreatitis and this can also reduce appetite and lead to weight loss.

Jaundice (when patients develop yellow eyes and skin) occurs in about a third of patients with chronic pancreatitis. It is usually due to damage to the common bile duct which drains bile from the liver to the duodenum. The common bile duct normally passes though the head of the pancreas. In long-standing chronic pancreatitis, the scarring in the head of the pancreas narrows the common bile duct. Some degree of narrowing may occur in up to half the patients with chronic pancreatitis but when the narrowing is severe, it prevents the bile draining from the liver into the duodenum. It then spills back into the blood and the patient's eyes and skin become yellow. In addition, the stools become paler (since bile makes the stools brown) and the urine becomes dark (because it contains more bile than normal).

Vomiting after meals is a less common symptom but can occur as a result of severe pain. It may also be due to duodenal ulceration, which is often connected with chronic pancreatitis. In rare cases, the duodenum may be narrowed as a result of scarring secondary to chronic pancreatitis.

Vitamin and mineral deficiency. Prolonged passage of stools containing fat can result in low levels of calcium and magnesium in the blood. In addition, some vitamins may not be absorbed properly. This includes vitamins D and A.

[beebug]

I had my gallbladder removed 11 years ago.  I started experiencing pain this past spring.  I too have been to several doctors.  They have run every test and they don't show anything is wrong.  The specialist I went to today told me that the only thing left is to do exploratory surgery.  I am willing to get rid of this pain!

[Suffering after Gallbladder removal]

Thank you all for your comments it is a least good to know I am not alone in my suffering.

I am going to try a new primary care physician and start the whole process over what ever it is has not gone away and perhaps will show its ugly head.

Thanks

[dollmindy]

Hi to all;
I to have had my gall bladder taken out about 4 months ago! Since then I have had the worst pain in my right side under my ribs it radiates up my back, I have had every test under the sun done even a colonoscopy at the age of 22. NOTHING and nothing showed up I had a couple of (small) polyps that were removed but aside from that everything looked fine, the doctors findings were IBS! I think that’s Bull**** and there has to be something wrong with me. I have had this pain and I wish I knew what the hell it was but I don’t know what to do from here:( anyone have any ideas? I’m just worried that something bad might happen, (knock on wood). But why am I in so MUCH PAIN AT THE AGE OF 22?

[toBethany]

My sister has "phantom" gall bladder pains.  The have prescribed something, but don't know the name of the drug.

Bethany

[krisg]

Definitely see a gastro doc. if anyone is experiencing pain after gallbladder surgery.  It is possible for stones to be lodged in the common bile duct or the pancreatic duct or the hepatic duct.  It can be life threatening if left alone.  For those us us (me included) who have severe painful attacks after gallbladder surgery , Sphincter of Oddi dysfunction is a strong possibility.  An ERCP is a must to rull out stones, etc. from the gallbladder surgery.  Then pressure measurements are taken to check for sod dysfunction.  The only problem with medical testing is that whenever I was at a doctors office or having out-patient testing all my tests were normal and bloodwork was fine.  When anyone has these debilitating attacks, it is a must that you request a liver panel (blood test).  The ER room usually only performs a CBC and checks for almalyese (spelled right) and lipase, which are only to check pancreatic enzymes.  Every time I had to go to the ER room, my liver enzymes were elevated.  Which is a strong indicator of SOD.  Like I said,  it is extremely important to have liver and pancreatic enzyme testing during the attack.  My ex-gastro specialist didn't believe me when I told him I had been having pain again and he never looked at my records from recent er visits and my liver enzymes.  I had to do the research myself and find another gastro. specialist who would look at the whole picture and of course my bloodwork when I was in the ER having these attacks.  Finally, I found a dr. who believes my pain and has ruled out everything else and has given my a diagnoses of SOD and strongly suggests I have a spincterotomy done soon.  I now have these attacks start on a daily basis and I don't think that is too healty for my body.  It has taken me 4 1/2 years now to find an answer to my medical concerns. Keep on looking for a compasionate dr. who is willing to work with you with medications and then last surgery if necessary.  Good Luck to All.

[5fan]

I too have had the pain that you have described since I had my gallbladder removed in July 2002.

I had moderate/severe acute pancreatitis when I went to the ER for my gallbladder and ended up in the hospital for six days before they finally did my surgery.  They needed to get my pancreatic and liver enzymes back down to a normal range before surgery.

I was in severe pain after my surgery, but at the time it was mostly contributed to the fact that I had a nicked artery during surgery and had to be opened up and the artery had to be fixed.  The surgeon said I would have more pain than most normal people when it came to recovery.

I ran a temperature and had nausea, vomiting and pain in the week after my surgery.  The surgeon put me on Augmentin and repeated my liver and pancreatic enzyme levels and also sent me for another sonogram to take a look at the pancrease again.

Finally, after four weeks of severe nausea and pain he referred me back to the gastroenterologist I saw in the hospital.  I had been taking Pepcid because the surgeon thought the surgery may have caused a slight ulcer.

The gastroenterologist did a work up on me including blood tests (liver and pancreatic enzymes); abdominal CT and a EGD (endoscopy).  The only "abnormal" results in these tests was that I had severe gastritis.  I was put on Nexium and given Librax to try for IBS.  The GI had warned me that it was possible these tests could all come back normal and that I may have IBS.  I did some research and was not really comfortable with an IBS diagnosis, but decided to try the medications and see if they helped.

I ended up back in the hospital at the end of September due to severe pain.  I felt like I was having gallbladder/pancreatitis attacks again.  All my blood work came back "normal" as did my urine tests.

My general practitioner aditted me to do some more testing - I can't tell you how many tests I had done including an MRCP to check the bile duct.  Everything was "normal".  I was sent home six days later with no diagnosis and a prescription for Reglan to help push food through my system faster.  

When I followed up with the GI after being released (I never saw him when I was in the hospital the second time.  I only saw his partners - one of whom told me there was no way I had chronic pancreatitis and that "you don't want it" when I asked if it was a possibility) he had decided that he didn't know what was wrong with me and that he was going to send me to a specialist here in Florida for testing for sphincter of oddi dysfunction.  He thought that that may even be a long shot because all I had were the pain symptoms.  My bile duct was not enlarged nor did I have elevated liver enzymes, but Type 3 SOD is pain only.

I finally went to the specialist on 12/23 (I had to wait three months for an appointment).  He was very informative and told me that he does not think I have just one condition at this point.  He ran blood work including trypsin levels and I found out Thursday that everything came back normal expect the trypsin level which means that I have pancreatic insufficiency!  The nurse said that he will call me Monday and most likely start me on enzyme therpay.

I went back today for a gastric emptying study.  Depending on the results of that test I may have to have a small bowel motility test done.  The specialist seems to think that because I have a fair amount of bloating and nausea that I may have a problem with how food is processed through my system.

If those tests come out "normal" he is going to go ahead and test me for sphincter of oddi dysfunction.  He wants to hold off on that tests because of the possible side effect of pancreatitis and the fact that I am one of the people with the highest risk factor of developing pancreatitis from the test.  The other tests are less invasive and he wants to rule out those conditions before moving forward.

I have to say that I have been having attacks since March 2002 (9 months now) and I finally am seeing some light at the end of the tunnel as far as what may be wrong with me.  I went into gallbladder surgery thinking nothing of it.  Never expected to come out with a nicked artery and still having pain.  

My suggestion to you would be to find a doctor who is willing to listen to your pain complaints and if he/she is unable to diagnose it be willing to admit it and send you to a specialist.  From what I have heard from people and from what I have read on the internet there are ususally good specialists and "teaching" hospitals that are connected to Universities.  The hospital I go to connected to the University of Florida and from what I have heard and read is the best place to be.  They are beginning to convince me of that.  When no one else could find answers they seem to be chipping away at them slowly but surely.

BEST WISHES TO YOU.

5fan

[Mr. Analysis]

I was surfing the web and came across your plight and I looked under bile on the web. The reason I was surfing is that my niece is having some problems with a gall bladder infection. When I got to your page I tought to look under bile. That's when I came to the cancer information network. There it talks about bile duct cancer. Remember the Doctors who removed the gall bladder weren't looking for cancer necessarily. Now the only thing left is the bile duct which is sill, or now cancerous.

[jojo723]

A related discussion, Gallbladder Removal to chronic pancreas issues?? was started.

[peach51]

A related discussion, Abdominal Pain was started.