Post-Sphincterotomy Pain

[thomasthecat]

I am a 34-year old female. I suffered my first bout of pancreatitis at the end of July after going to Russia on a business trip and studying for the bar. Instead of taking the bar I spent five days in the hospital. When released pain was mostly resolved, but enzyme levels continued to be elevated. CAT scan imaging mid-August confirmed I still had pancreatitis. I saw a specialist who ordered MRCP mid-September, which suggested pancreas divisum. Advised of the relative risks and benefits of ERCP sphincterotomy I declined until started suffering epigastric pain mid-November. Dec. 1 ERCP confirmed divisum and sphincterotomy perfomed with stent to prevent pancreatitis. My diet since July is strictly soup, salad, and fruit and no alcohol. I began taking loestrin again Nov. 27.  I have had various degrees of epigastric pain since the procedure varying from mild to somewhat severe, but not enough to make me check myself into the hospital. I still make it to work everyday. I am starting to get depressed of the constant pain. I don't know what else to do. Is this normal or expected? Should my physician prescribe something for the pain? Is the pain a signal of chronic pancreatitis? What are the long term effects, if any, of simply managing pain without resolving problem?

[Kevin Pho, MD]

With the ERCP and MRCP being performed, that would have thoroughly evaluated the biliary tracts.  If the symptoms continue despite the sphincterotomy, that would open up the possibility that something else is going on.  

You can consider an upper endoscopy to evaluate for GERD, an ulcer, obstruction or inflammation of the upper digestive tract.  More specialized testing, such as esophageal motility studies as well as a gastric emptying scan can also be considered.  

These options can be discussed with a gastroenterologist.  If the pain continues despite the GI workup, you can consider a pain clinic to help manage the pain.  As for long-term effects, I cannot answer that without knowing what is causing the pain.

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

[thomasthecat]

Thank you for your advice. Over the weekend I began to feel some cramping in my right chest in addition to the non-stop epigastric pain. My husband called the hospital and the doctor on-call thought the cramping was a side effect of my passing the stent. I think it might have been since I began feeling bounds better starting on Monday. I am getting a UKB on Thursday to verify that the stent is gone. I feel "cured" however in the past when I have felt better I have pushed by self diet-wise and ended up in pain again. This time I'll take it slow.