Major Pain in Upper Right Quadrant

[Mamainpain]

Hi,

I am 29.  In April of 08 I had my gallbladder removed.  In July of 08 a sever attack of pain came on and did not subside.  Following a week stay in our local hospital to evaluate the situation our local GI specialist sent me to Denver to have a sphincterotomy.  When they did the cholangiogram they discovered 2 strictures on my common bile duct.  They put a stint in and said they wanted to leave it for 8 weeks.  At 3 weeks the stint got plugged so my local GI doctor removed it with the permission of the Dr.s in Denver.  I had terrible pain while the stint was in and still more pain after they removed it.  I have been experiencing elevated pancreas enzymes since a week after they put the stint in until this week(11/3/08) my pancreas improved but the sever pain that put me in the hospital in July came back.  The GI Dr. thinks it is IBS but my Family Dr. says that IBS should not wake me from sleep.  

I had a sonogram yesterday(11/6/08) and they told me that my bile duct was dilated but that is normal for me!!!  I just would like to know why my pain is still of sever and if those strictures can be causing me problems again.

PLEASE HELP!!!!!
Tina

[Kevin Pho, MD]

I agree with the testing done thus far.  An ERCP or MRCP would be the test of choice to evaluate whether there continues to be dilation of the bile duct.  A Sphincter of Oddi manometry can be considered to evaluate whether there is dysfunction there.  Continuing with the sphincterotomy can be considered if the pain continues.

If the tests remain negative, an upper endoscopy can be considered to exclude dyspepsia.  Irritable bowel syndrome is reserved for cases where there continues to be no clear cause.  

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[Banned1]

Hi Mamainpain:

How are you feeling?  It's been a while since your initial post.  Have you had an ERCP and MRCP yet?  Is there any change in your pain level?

Hang in there!