Pain after gall bladder removal

[Alderica]

I (female, 43) had my gall bladder removed in November 2008 after years of chronic cholecystitis. As the inflammation didn't show up on any ultrasounds, it went undiagnosed for years and upon removal, turned out to have developed into a porcelain gallbladder.
Everything was fine afterwards provided I avoided fatty foods and too many eggs or milk products. However, of late, the pain in the right upper quadrant has returned almost as bad as before and flares up irrespective of what I eat (I eat a healthy diet with practically no sugar, fried foods etc.) However, apart from GGT being up to about 200 during such phases, my blood work is fine and ultrasounds have revealed no problems (although I am rather distrustful after previous experiences).
What could this be, and what step should I take next?
Many thanks in advance!

[Christopher R Watters, MD]

You are very young for a porcelain gallbladder. As you probably know, many if not most of these turn iinto cancer if not removed. The fact that your GGT is elevated argues for something going on in your common bile duct. The fact that nearly four years has passed would argue against a retained stone but the first test should probably be a MRCP to rule out ductal pathology. The other possibility is sphincter of Oddi dysfunction. This would be more likely given the elevated GGT.

[Alderica]

Ah, that's a great help, thank you very much. I have had phases of pancreatic type pain, but my amylase levels have always been normal. I'll put these ideas forward to my primary healthcare provider and see what she says. Thanks again!