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Avatar universal

Problems after gall bladder removal

In Feb of 2002 I had my gall bladder removed.  No stones, just a lot of pain and acid reflux.  The surgeon said the gall bladder was full of "sludge".  A year and a half later I am still having pain.  

The pain seems to be concentrated right at the bottom of my rib cage on my right side, but also extends around to my back.  The feeling is like there is a lot of pressure under my right rib cage.  It generally gets worse after a meal.  A large meal will always bring very intense pain.  I have had a couple of sonograms and a CT scan and they found nothing.  About half the time blood tests show that my ALT is slightly elevated.  Had a liver biopsy about 4 mo ago and the only finding was a slightly fatty and irritated liver.  

I have been on nexium for about a year, but acid reflux doesn't really seem to be a problem any more.  It was before the surgery.  In November of last year an EGD revealed a duodenal ulcer.  Haven't had another EGD since then so I don't know if the ulcer has healed or not.

Most recently I changed G.I. doctors because I didn't think the first one was going after it aggressively enough.  This is affecting my life and my ability to work and spend time with my family.  

The new doctor put me on Mycelex (spelling?) a prescription laxative.  He also ordered an MRCP which was performed last week.  Should get the results back tomorrow.  

These doctors keep suggesting to me that his pain is "psychological", that certainly is not the case.  I am a 42 year old male, very active (at least I used to be), 5' 11" and 215 lbs.  

I also feel very tired and lethargic much of the time.  Unless you can give me some help, I guess my next step (if the MRCP shows nothing) will be to ask my general doctor to refer me to the Mayo Clinic.
11 Responses
233190 tn?1278553401
Hello - thanks for asking your question.

I agree with the suggestions below suggesting testing for pancreatitis, as well as the ERCP with manometry to test for Spincter of Oddi dysfunction.  This disease is more prevalent in those who have had their gall bladders removed.  Treatment may include sphincterotomy, surgery, medications (i.e. nitrates, calcium channel blockers), electroacupuncture or botulinum injection.  

Another consideration would be a non-healing ulcer.  You may want to inquire about a repeat endoscopy to demonstrate healing.  Another test to consider would be H Pylori - which can be treated with antibiotics.

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.
Avatar universal

Ask your doctor for a blood test for Amylase and Lipase levels to rule out pancreatitis.  When your in pain is the best time to draw the blood.  If you have pancreaittis, the levels will be elevated at this point.  And hopefully the MRCP will show something. But it doesn't always.  I just had another CT Scan and it came back fine.  Said my pancreas was unremarkable yet I have Moderate Chronic Pancreatitis that I got from a bad Gallbladder surgery.

I am not suggesting to you that that is what is wrong with you, but it is important to have that checked.  Sometimes it's the last thing the doctor wants to look for.  All the GI's I had been to kept telling me that I couldn't possibly have that since I was, according to the doctors, grossly obese (I'm 5'10 and 198 pounds)a woman, a non-drinker and under 40.  They kept calling it IBS, they said it was all in my mind, I was making it up for attention, etc.

I finally got to a university and was diagnosed when my chart got there.  That was 1 week before I ever had the appointment and met with the teaching professor.  So keep plugging away.  Ask for the amylase and lipase bloodwork. Do it while in pain and not in pain so you have a comparison and also ask for a Fecal Fat Test.  Keep all your basis covered and good luck!

Sandy (TazLady)
Avatar universal
I think ERCP, with manometry, is something to consider. That means passing a tube like with EGD, injecting dye into the bile duct, and possibly measuring pressures in it. The entities to rule out are a stone in the bile duct, or sphincter of Oddi dysfunction (SOD), meaning the "valve" at the end of the bile duct squeezes too tight, causing pain like you are having. It can be treated at the time of the ERCP. by cutting that valve (sphincter) to open it. Ask your gastroenterologist about it.
Avatar universal
You should make sure to be fully informed regarding the nature and frequency of significant potential complications from the sphincter of oddi manometry procedure.
Avatar universal

I posted above.  I also have SOD and have had the monometry done.  They cut the sphincter and still I have some problems to this day.  What complications were you referring to?  Is it about bringing on a pancreatic attack?  Because thats when my worst attack ever came and I spent 9 days in the hospital.

Avatar universal
I don't have the citation handy, but if memory serves SOM has a 25-50% rate of pancreatitis - and particularly so in patients with SOD.
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