CBD Stricture noted post-laproscopic gallbladder removal

[Over_Dairy]

My hub. who was treated with surgery/radiation for seminoma 15 years ago had his gallbladder removed two weeks ago and the dye test showed a CBD stricture (narrowing that appears like a "squeezing" rather than an internal obstruction).  (Prior to surgery his ejection factor was 15% (instead of normal 45-65%l) but ultrasound showed no stones.  Post-op Pathology showed mild chronic inflammation but no stones/sludge.  He still has intense upper quadrant pain and pale stool.  Next step is an ERCP.  Read online in a UK journal that radiation for seminoma can cause CBD stricture.  Ever heard of this?  Also, would MRCP be an adequate first step instead of ERCP to limit his further radiation exposure? Any other suggestions?  Anyone else had this happen?


This discussion is related to What is going on with my liver � bile duct system?.

[CalGal]

Make sure he stays on a low fat diet across the board. He's not going to be able to process fats as he once did, and it may take some time for his system to re-adjust.

[Over_Dairy]

Thank you!  
Truthfully, I am really hoping it was an after-effect of the radiation because almost all the other possibilities look overwhelming.  Hopeful, too, because pancreatic enzmyes continue to be normal.

The most interesting part of this is that an ER doc recommended this procedure BEFORE the surgery was on the board.  But gastro (#2) declined, saying it's "too dangerous" and referred to the surgeon. Post-op, with the surgeon recommending it too, gastro(#2) provided a referral to gastro(#3) but with the caveat "no rush." Of course hub (in constant pain) disagrees so gastro#3 appt is next week.

Note: When hub first presented with pain, gastro(#1) diagnosed GERD, doing an endoscopy/biopsy for Barrett's esophagaus.  (Negative but some "possible  displasia." Prescribed acid inhibitors -- pain unresponsive / gastro#1 unresponsive.  Enter gastro(#2) who moved forward to investigate the Gallbladder. Now up to gastro#3 -- beginning to wonder how many gastros it will take to get this resolved....  (Sounds like a new card game or quiz show!)  Insurance plan/employer must LOVE this....

[CalGal]

It's possible that abdominal radiation could have caused CBD stricture.

MRCP would not do much to help unless all you want to do is further visualize whether or not the 'closure' was a focal spasm instead of a stricture. Nothing can be done to resolve the problem using MRCP.

During the ERCP they can measure pressures within the duct and at the sphinctery, if that is part of what they would like to accomplish. But the major aspect that I believe they may be attempting during the ERCP would be to balloon the portion of the duct that is narrowed. In addition, they'd be able to sweep the duct for any stray stones if they're present, and check to see if the entry to the pancreatic duct is clear.