Spasms in URQ following Gallbladder Surgery

[MichaelnTammy08]

Hello, first time poster! My wife had her gallbladder removed May 21, 2009 after suffering from severe URQ pain. She actually had around 75 stones which I was blown away after the Surgeon told me. Anyway, I would say 2 or 3 weeks after surgery, she started getting squeezing sensations from the sternum and down the URQ which cause her to lose her breath. She said it feels like someone punches her at times. They can be brought on by bending over, walking stairs. etc and also by pressing on sternum and URQ area. She initially thought it could be heart problems. However, that was ruled out through a stress test EKG. The family doctor and surgeon think it's possible it is Esophogus Spasms/Hiatal Hernia. The symptoms seem to be getting worse and more common especially the breathing. My wife is very active around the house and has been painting and working around the house etc more lately. So with the symptoms getting worse we went back to the surgeon. He ordered a liver and pancreas test, but we have yet to get the results and he also is referring us to a GI doctor. Anybody have anything similar following Gallbladder surgery?

Thanks,
Michael

[terik64]

I had my gall bladder out in 1985.  A few years after, I started getting the spasms where the gall bladder would be.  The pain is intense!  They started coming maybe 2 or 3 times a year.  I had all the blood tests done, I have had numerous tests with the scope down the throat, put on antacids.  It took the doctors 13 years to figure out it was muscle spasms.  In 2000 a doctor gave me some cortisone shots in that area and I have not had an 'attack' as I call it, in 13 years.  Last Friday night, it came back with a vengeance.  3.5 hours of horrible pain, that shoots through your chest to your back and the tightness makes it hard to breath, talk, walk.  Although I have had a spasm last for several hours, this had to have been the worst.  The tightness was so severe!  

[CalGal]

Laura, cut and paste this link http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Disease_ID=7AB086B0-AB01-446E-B011-2E67CAFEF96D&GDL_DC_ID=320F4EDD-0021-4952-83D7-8B0C67B47BFF

It will give you an overview of what might be going on. While you're waiting to get to the bottom of the problem, try following a very low fat diet and see if its of help.

As the doc said, please make sure ALL tests are done to find the cause of the discomfort. Something to keep in mind is the ERCP should include use of a step called manometry - a reading of the pressures in the duct. Some docs use ERCP without the pressure reading step and routinely cut the duct 'just in case.' This is a step that should be looked at very critically and discussed. In some cases it's been found that cutting the duct without the presence of raised pressures may NOT be a good step in the long run. The only person that can help to lead you through the process is a darned good biliary gastro person - one that has specifically dealt with this type of problem in the past.

[Christopher R Watters, MD]

Biliary type pain after having a gallbladder removed can be miserable. The most common cause is a retained or new stone in the bile duct. If this has been ruled out by either ERCP or MRCP and other structural problems have also been ruled out such as ulcers, etc. then Sphincter of Oddi Dysfunction (SOD) becomes much more likely. If your bile duct has been noted to be dilated and you have had any elevations of liver function tests there is a 90-95% rate of resolution of symptoms if the sphincter is cut using an endoscope. You need an evaluation by a competent biliary gastroenterologist who deals with this problem. This typically is unavailable outside of a tertiary care center.

[laura_walker1990]

Hi, my name is laura. I have been goign throught this since dec. feb 3 I had my gallbladder removed, it was so odd shape that it had to come out. But about 17 days after I started t have upper abdomine pain. now its off and on almost every day. some days its er days bc my pain meds wont stop it. They have ran every test possible with out cutting me open again. Its just getting worse with throwing up and cant live a normal day life. I am only 22 yrs old. i am out of options. it is so frustrting to me that none of my doctors and surgeron dont know and cant find out whats wrong. Any advise?

[Matthew007]

Allo, :)

Hey you're welcome good luck on figuring that out :S probably sounds like either an endoscope or more thyroid testing/biopsy to find out what is up with that..hopefully they'll figure it out soon that is a bit scary.  On the plus side i'm glad the test came back negative..you dodged one bad one there.. some people with SOD just do not get better and live in constant pain so at least that has been ruled out completely :)  Maybe the URQ is still an ulcer..and endoscope would confirm that..but yeah best figure out that thyroid issue first.  Good luck - hope she gets better! :S

[MichaelnTammy08]

Thanks for all the info Matthew! Blood tests came back negative. The sqeezing has gone but she still is out of breath feeling like she has been punched in the stomach. The Doctor claims it can't be a bile duct problem with good blood test. She also had her oxygen measured which was normal at 97. Also, early CAT scan showed no hernia which they thought it could be. One more thing, a few weeks ago they detected a 1.1cm nodule on her thyroid. She has had feeling of something in her throat for years which could expain that. I also wonder if that could cause the problem in her sternum/URQ. We will be going to a thyroid specialist on Thursday and hopefully find out more. Finally, I suppose it could have been a stone that just passed, but after surgery they checked and saw none in the bile duct. Thanks again!

Mike.

[Matthew007]

if she is really improving maybe a stone passed through finally, and maybe it's just residual inflammation from the stone passing that is causing some of the pain/breathing issues.. a good diet to watch and clean out stones is to avoid fats and oils until this gets figured out.  Also for a cheap home remedy to try is to get some prilosec from the store..take one or 2 half hour before breakfast...but i'd consult the dr first...but that way you could maybe rule out or help rule out an ulcer.  

[Matthew007]

you're welcome :) hopefully we're both wrong and it's something simple and dumb like an ulcer...but yeah I suspect SOD as well..when I had my gallbladder removed the doctor did mention it's common to get ulcers after the procedure so maybe 2 weeks on nexium would be worth trying (worth a shot..)

She could also try to use a warm blanket or heating pad over the general area..try and sooth and relax the muscle to see if helps at all..or eat easy items for a day like jello and such just to see if it makes any difference.

..there is a yahoo groups available for SOD patients that a lot of people are on you can look for help (this site doesn't allow you to post links) but yeah I'd wait for that blood test result and ask about MRCP from a GI specialist.  They'll probably have no problem sending her to that test...now ERCP that's another story and if you do that - only go to someone who's done a bunch of those tests before..and there's a pressure test called mammotry or something like that that is important to test if you do go that route.  Most doctors won't touch you with a 10ft pole if your blood tests and MRCP are negative though just a heads up :S  Anyway good luck!

[MichaelnTammy08]

My wife now says that she hasn't had the sqeezing for several days but still feels you was punched and out of breath a lot when she is not laying down. Could the mean that the problem may be resolving itself on its own? We're still obviously going to persue further but just wanted your educated or experienced guesses if you have them. Thanks so much again...so nice to be able to get advice when a doctor is obviously not always available =-)

Michael

[MichaelnTammy08]

Thanks guys...I will push for an MRCP then!

[Matthew007]

calgal beat me to it LOL :)

[Matthew007]

Well first off..that s u x i'm sorry to hear that she's having a hard time..

Yeah that pancrease/liver test will actually tell a lot..especially if the liver blood test is elevated.  Sometimes after gallbladder surgery there's a thing called S.O.D.  (i'm not going to try and spell it out since i'm a bad speller..but anyway there's a valve that opens and shuts right at the very enterance to the intestines from the gallbladder/liver.  That's where the bile now freely flows out of since your wife had her gallbladder removed.

When you eat..it *normally* closes and then after food passes it opens up again.  It's all done by a muscle.  Well sometimes a stone going through there can either irritate it or the muscle can spasm and lock up and not release causing pain..and bile to back up (which would show up on your liver blood test).  If the blood test comes back normal I honestly might try again..you have to be basically having an attack when you do the test.  There's also an MRI test called a MRCP, that views the bile duct..normally found with SOD to be inflamed and such....usually they place a stent or cut the muscle so the opening (drain) can be open all the time..BUT they only do that if there's evidence of a problem either with imaging or blood tests and they rarely like to go in if both are lacking since there's a risk to develop SOD just by testing for it.


OORRR...this is just post operative gallbladder pain..there's a name for it but I can't think of it off the top of my head but some people just have chronic pain after gallbladder surgery.

Either way you gotta wait for those blood tests and if you do have insurance maybe a MRCP would be a good idea to check..or ask the GI specialist what he thinks...could be STILL stones..people get them even after gallbladder removal and one could be stuck somewhere (MRCP would catch this normally)

Good luck :S

[CalGal]

Michael, an unfortunate number of people have this happen after surgery. It can in some cases come from a stone that is 'lost' from the gallbladder to the common bile duct during surgery. But it can also occur due to spasms that occur in the CBD or the opening to the duodenum of the CBD, the sphincter of Oddi (SOD). If it is SOD, it needs to be looked at and diagnosed ASAP. Ask the doc about SOD - which is often misdiagnosed as GERD or other GI issues. There's a good link to the condition at the John Hopkins website.

If the liver and pancreatic blood tests were not done while she was having an attack or within 12 hours of having pain they could come back normal, so keep that in mind if you're talking to your doc. Also, request that the doc do an MRCP to look for lost stones. In the meantime, if it is SOD, it will be made worse if she takes any form of narcotic-based meds.

Try staying on a low fat diet. It can sometimes be of help, and should have been recommended after the surgery was done.