post cholecystectomy pain

[Lor]

I had my gallbladder removed in November of 2000. Right after surgery I developed severe upper abdominal pain. I went from Dr to Dr searching for answers to my pain. After a year and a half I was finally diagnosed with SOD by ERCP with menometry whiched found high pressure in my bile duct. I also had elevated liver ensymes. I had a sphincterotomy done on my bile duct and the pain went away.
Now the pain is back - though not daily ,and by far not as severe. My question is: my pain always starts with an empty stomach. First sign is hungar pains which quickly turns into a sharp pain just below the sturnum. This is the same pain I had before my shincteromy. I am not able to go through the night without getting up to have something to eat. I've had several EGD's that have found no ulcers or gastritis. Is there anyway to stop this pain or how to go about finding out what is causing it? Is it possible the sphincter has formed scar tissue that has to come out?

[jay c]

My wife had her gallbladder removed in 1994. She has had infrequent pains on her right side since then, and Soma has controlled it fairly well. But last year she was in a car accident. Since then flair-ups have become an almost every-day occurrence. Pain medications don't do anything except at such high doses that she becomes incapacitated. Soma still works, but she has a tendency to take too much if the pain is severe,  I'm not comfortable with the idea of her being dependent on this medication for the rest of her life. I looked at levsin, but the side effects sound worse even than most pain medications. From what I've gathered by reading this forum and other web sites, there is medically nothing that can be done. Just eat a low-fat, high-fiber diet, and learn to live with it. Is that really the only answer?

[Lor]

I was on questran for about 7 months. It did work for me, but had to stop taking it because I no longer had a problem with loose stools. I've switched to taking metamucil when needed. It seems to bind everything up and give me the full feeling my body needs. I choose not to take it daily - I don't want my body to become dependant on it. My liver ensymes came down into normal range after my sphincterotomy. I went in during one of the attacks and checked out fine. I figure I will let this take its course as long as I can then go in and have it done again. Like I said the pain isn't nearly as bad as it was.

[TOOTINA]

I HAVE HAD THE SAME PROBLEMS AS YOU....AND ALSO THE SAME TESTS SINCE MY GALLBLADDER REMOVAL IN FEB.2000. MY M.D. PUT ME ON QUESTRAN LIGHT BID...TASTES TERRIBLE ...BUT IT MAKES LIFE BEARABLE. MY HIDA SCAN FUNTION WAS 3%..SO THEY FIGURE SOD..BUT I WILL NOT DO ANOTHER ERCP...BESIDES ..IT SEEMS EVERYONE SYNPTOMS COME BACK AFTER FIXING THE DUCT..HOPE THIS SUGGESTION HELPS.

[krisg]

Have you had elevated liver enzymes recently with an attack of pain?  I'm curious because I just had my 2nd ercp and the dr. had to do a generous sphincterotomy just to access my bile duct.
One hour after I awoke from the surgery I was back in the ER room with a severe attack again!  Of course they thought pancreatitis, as so did I, but blood tests revealed only elevated liver enzymes again.  Of course the dr. was stumped and put me on an anti-inflamatory for 2 weeks, with pain meds.  I feel alittle better each day but noone can explain the elevated enzymes with colic (after the procedure).  The dr. said I should have felt fine.  I should mention also that he had to clean my bile duct too.  There was high grade stenosis. My only conclusion is that my duct swelled shut after the procedure, causing my bile to back up into the liver temporaily. Does this make sense ???

[schaeff]

Although I have not had the SOM and sphincterotomy procedure, and as such my SOD is presumptive, my symptoms began the day after my gall bladder was removed in 1999 and are identical to yours - excruciating epigastric pain that radiates to the RUQ and back, beginning with hunger pangs about 3 hours after the last meal. I am also awakened most mornings (5-6 a.m.)with a pain in the back that quickly escalates into the usual severity and location if I don't address it. All the scopes w/biopsies and CT and MRCP and liver enzyme blood tests normal.  You might try the couple of things that work for me. At the very first sensation of hunger pang,(if you've learned to live with this you recognize it very easily) drink a tall glass of water. Eat smaller, more frequent meals, rather than 3 regular meals.  If I am stuck without water or food (as I was recently when stuck on a plane on a runway awaiting a delayed takeoff), two levsin, .125 sublingual (under the tongue), at the very first sensation, will work for an hour or so.

Hope this is useful.  What the previous poster said about scarring of the sphincter causing restenosis following sphincterotomy is reported in the SOD literature.

[surgeon]

a certain percentage of sphincterotomies will scar down over time; another ERCP might be able to determine this. It can become a difficult problem, because SOD is still not fully understood, and manometry, etc, are only partial indicators. So when symptoms persist after treatments such as you have had, it gets increasingly difficult to pinpoint the cause. However, having had what sounds like an improvement from the sphinterotomy, one might consider looking into the anatomy of the area again.