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Phantom gallbladder pain
I had my gallbladder removed 2 1/2 years ago. 10 months ago I had to have a wayward gallstone removed that had lodged in my bile duct. Lately, I have been having "phantom" pains where my gallbladder used to be. Nothing like gallstones, just sharp pains. Could there be another runaway gallstone? My liver function was off because of the last one, could this be the problem? Please help.
From website - http://www.ddc.musc.edu/public/problems/diseases/pancreas/sphincterOddi.cfm
SPHINCTER OF ODDI DYSFUNCTION (SOD)
SOD describes the situation where the sphincter goes into “spasm”, causing temporary back up of biliary and panctreatic juices, resulting in attacks of abdominal pain (or pancreatitis). 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). SOD 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.
DIAGNOSIS OF SOD
Initially, tests are aimed to make sure that there are no other problems present, like a stone or small tumor. Standard ultrasound and CT scans are helpful, but not very accurate in detecting or excluding small stones. Newer techniques such as MRCP and endoscopic ultrasound are more sensitive, and useful. Most patients are investigated with ERCP, with Sphincter of Oddi Manometry (SOM). For ERCP, the doctor passes a special flexible endoscope (under sedation or anesthesia), to examine the drainage hole of the bile duct at the papilla of Vater. Dye is injected into the bile duct and pancreatic duct to double-check for stones and other forms of obstruction. The possibility of sphincter spasm (dysfunction) is tested during the ERCP by measuring the “squeeze pressure” in the sphincter, with manometry (SOM). SOM is performed only in special referral hospitals. Like all types of ERCP examination, there are risks, particularly the chance of suffering an attack of pancreatitis. For this reason, ERCP in this context is usually done only after other simpler tests have been exhausted.
TREATMENT OF SOD
Mild forms of SOD can be managed by anti-spasm medicines. When attacks of pain cause considerable disturbance with life activities, a decision has to be made whether to cut the sphincter (sphincterotomy), during ERCP. When sphincter of Oddi manometry has confirmed that the pressures are high, sphincterotomy gives good relief in most patients (but not all). The performance of sphincterotomy carries a risk of complications, such as bleeding and perforation, in addition to pancreatitis. There is also the possibility of recurrent symptoms after months or years due to scarring of the sphincterotomy. Further cutting (repeat sphincterotomy) is sometimes possible, but there are limits; surgical treatment with a transduodenal sphincteroplasty may be necessary. Transduodenal sphincteroplasty may also be recommended in lieu of ERCP in patients who have undergone previous gastric surgery.
Sphincter of Oddi Dysfunction is a difficult condition, which should be approached and managed with considerable care. Patients may warrant referral to specialist centers, who often have special research protocols.
SPHINCTER OF ODDI DYSFUNCTION (SOD)
SOD describes the situation where the sphincter goes into “spasm”, causing temporary back up of biliary and panctreatic juices, resulting in attacks of abdominal pain (or pancreatitis). 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). SOD 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.
DIAGNOSIS OF SOD
Initially, tests are aimed to make sure that there are no other problems present, like a stone or small tumor. Standard ultrasound and CT scans are helpful, but not very accurate in detecting or excluding small stones. Newer techniques such as MRCP and endoscopic ultrasound are more sensitive, and useful. Most patients are investigated with ERCP, with Sphincter of Oddi Manometry (SOM). For ERCP, the doctor passes a special flexible endoscope (under sedation or anesthesia), to examine the drainage hole of the bile duct at the papilla of Vater. Dye is injected into the bile duct and pancreatic duct to double-check for stones and other forms of obstruction. The possibility of sphincter spasm (dysfunction) is tested during the ERCP by measuring the “squeeze pressure” in the sphincter, with manometry (SOM). SOM is performed only in special referral hospitals. Like all types of ERCP examination, there are risks, particularly the chance of suffering an attack of pancreatitis. For this reason, ERCP in this context is usually done only after other simpler tests have been exhausted.
TREATMENT OF SOD
Mild forms of SOD can be managed by anti-spasm medicines. When attacks of pain cause considerable disturbance with life activities, a decision has to be made whether to cut the sphincter (sphincterotomy), during ERCP. When sphincter of Oddi manometry has confirmed that the pressures are high, sphincterotomy gives good relief in most patients (but not all). The performance of sphincterotomy carries a risk of complications, such as bleeding and perforation, in addition to pancreatitis. There is also the possibility of recurrent symptoms after months or years due to scarring of the sphincterotomy. Further cutting (repeat sphincterotomy) is sometimes possible, but there are limits; surgical treatment with a transduodenal sphincteroplasty may be necessary. Transduodenal sphincteroplasty may also be recommended in lieu of ERCP in patients who have undergone previous gastric surgery.
Sphincter of Oddi Dysfunction is a difficult condition, which should be approached and managed with considerable care. Patients may warrant referral to specialist centers, who often have special research protocols.
I also had phantom gallbladder pain after having mine removed. My pain was like yours, where my gallbladder used to be. It did turn out to be a stone lodged in my common bile duct. I happened to pass mine and have not had pain since. If the pain continues, I would return to your doctor to find the offending stone. The pain I know is awful and I have heard that even without a gallbladder, if there continues to be blockage in your bile ducts it can cause further health problems.
Its likely, once gallstones are removed, there is a strict diet involved, were you given a diet to follow, because its important that you stay away from acidic or greasy type foods. You have to eat plain foods. There could be another galstone, but I am not sure, it may be possible. Your liver should not be affected at all, since your galstone has been removed already. Other advice is to go see a doctor and maybe get an ultra sound done.
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