Post-Surgery Problems

[missa090]

I'm a 23 yo female and I had my gall bladder removed laparoscopically about 6 weeks ago.  I had ongoing pain (although no "attacks") for a few weeks and was admitted to the hospital with pancreatitis, a low grade fever, and elevated enzyme levels.  My pain gradually remitted while I was in the hospital, and the ultrasound as well at the other test I had (drinking a fatty drink to test the function of my gallbladder) were clear except for a small polyp.  They found no stones, but theorized I had passed a stone before the tests which caused the pancreatitis, and decided the gall bladder should be removed to prevent it from happening again.  I recovered quickly and felt great about two weeks after the surgery, other then bowel irregularities.  Soon after I developed severe heartburn (which I've never had before) and woke up one night with what felt like my esophagus or something spasming (also never had) every 30 seconds or so when I would double over in pain.  I went to the ER and was given pain medicine, they also did several abdominal xrays and blood tests which they said were clear.  Before the surgery I'd had many tests, including metabolic and liver work ups and chest xrays, an ekg, chest CT, all clear.  I was put on nexium, but over the next few days got severe hives and they switched me to ranitidine 150 mg twice a day, Tums, and Claritin (with benadryl once in awhile) for the hives.  The heartburn is persisting, although it goes away as long as I don't miss any medication and I haven't had spasms again.  The hives pop up sporadically, i've got at least a few on my body at all times, they're large, irregular, blotchy and strangely not really very itchy at all.  I'm also fatigued much more easily than before surgery.  My main concern now is severe pain on my right side under my ribs, which comes and goes but keeps me from lying on my right side at night and is always tender to touch. It tends to be worse towards the back, and i think i may feel a slight soft lump, maybe 4" across and not very thick, up under my rib (although i'm not positive). My original symptom (way before surgery) was pain in my right AND left UQs, which led my doc to originally suggest a possible intestinal infection or irritable bowel.  The pain is almost identical and if i eat a large meal i do have some urgency, i also think i've seen some mucous in my stool, but only the last week or two.I'm currently putting myself on a super bland, mostly liquid diet to see if it helps to balance out.  I am overweight by about 50 lbs, which was gained pretty rapidly in the last two/three years, and i'm also a smoker.  My mother had lots of gallstones and had her gall bladder removed in her 30s.  Both of my parents have thyroid problems, but neither was diagnosed until their 40s (father underweight, mother overweight).  This RUQ back pain is really troubling, as are the hives, and I'd appreciate whatever directions you can point me in.

[Kevin Pho, MD]

You can consider various upper GI disorders - like gastroparesis, ulcers, or inflammation.  An upper endoscopy can be suggested to evaluate these possibilities.

Post-surgical changes or complications (i.e. bile duct leak) should also be considered, and initially evaluated with an ultrasound.

If the tests remain non-revealing, one can consider Sphincter of Oddi dysfunction.  An ERCP with Sphincter of Oddi manometry can be considered to evaluate this uncommon possibility.

These options can be discussed with your personal physician, or in conjunction with a gastroenterologist.

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.
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