When to Expect Gangrene

[DaisyLou]

During the week of December 5, I developed right upper abdominal pain while in the hospital following a thyroidectomy. I attributed the RUQ pain to stuffing myself with hospital food for three full days (had been on a low-fat, low carb diet for a few months prior). I was also on a calcium drip and taking calcium supplements. The supplements continued at home for a couple of months until the parathyroids kicked in. Now six months later, I still have the RUQ pain.

I have many diagnoses: bad gallbladder, good gallbladder, adhesions, no adhesions, good colon, redundant colon. Although the diagnoses disagree, all my doctors insist that I see a surgeon. (See Medical Information at bottom.)

So far I’ve been admonished by three different surgeons for wasting their time. The last one, a colon surgeon, said that I undoubtedly had acalculus cholesystitis and that I should get someone to remove my gallbladder. Based on my experience, I’m going to have to develop either gangrene or a perforation before anyone will touch me.

QUESTION: How long do I have to wait to get gangrene or a perforation, and is there something I can do to hurry it along?

Thanks,

Daisy

MEDICAL INFORMATION

RUQ pain (base of ribs) 2 to 5 hours after eating, always after fatty foods. Pain radiates to back. Starts as stabbing pain followed by ache for a few hours. Hurts when I lay back on pillows with my hands over my head and when I scrunch over in a chair.

Normal: US (1/14), CT (1/14), HIDA-94% (1/25), MRCP (4/3), lower GI (5/22)

Not a Concern: Endoscopy (2/3) – deuodenitits involving the duodenal bulb, moderate-sized hiatal hernia with ulcerative distal esophagititis (been on Nexium since 2/3)

Not Sure if It’s a Concern: Colonoscopy (5/1) – Mild diverticulosis of the left colon and some redundancy of the colon, otherwise normal to cecum. (I’m been taking fiber supplements. Immediately after the colonsoscopy, the GI doctor said that he thought redundant colon was causing the pain, but at the follow-up appointment he denied it.) Lysis of Adhesions (2001 and 2002) mid-right abdomen at waist (involved small bowel, colon, omentum, and abdominal wall). I believe adhesions have been causing RLQ pain for the past few years. No prior surgeries. Other than the typical childhood illnesses, I’ve been disease free.

Puzzling: Elevated lipase 95 H [22-51 U/L] and amylase 205 H [36-128 U/L] (1/14). (I am not a drinker, though I’m seriously considering taking up drinking.) Three days later levels were normal.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation for your symptoms.  With the normal HIDA scan and ultrasound, it is unlikely that the gallbladder is contributing to your symptoms.  This is why the surgeons are so hesitant to do surgery.

The inflammation of the small bowel (duedenitis) can contribute to your symptoms.  If the Nexium isn't helping a 24-hr pH study can be considered to evaluate abnormal acid production.  

Otherwise, if the tests continue to be non-revealing, you can look outside the GI system.  A referral to an orthopedist can be considered to evaluate the musculoskeletal system, or a pulmonary physician to look at lung causes.  

Regarding the elevated pancreatic enzymes - a normal MRCP would rule out biliary blockage.  An endoscopic ultrasound can be considered to image the pancreas for any masses.

These options can be discussed with your personal physician.

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_