EUS of Ampulla

[bluewater22000]

11 years ago I had my gallbladder removed. I got jaundiced due to a stuck stone and went to the ER. After an ERCP to remove the stone and stenting, I had the surgery. According to the surgeon, there were over 100 stones in the gallbladder and it had gangrene. He let me know I was lucky to get the stone stuck because I would have been dead in a couple weeks. I thanked him. One month after surgery, I had the stent removed. I immediately became jaundiced again, and began running a low-grade fever. After another investigative ERCP and colonoscopy, the GI doctor essentially washed his hands and turned me over to my Internist. The fevers progressed by month rising a few degrees each month, but lasting only 14-16 hours per day. By the fifth month they were 105.5. I saw Infectious Disease doctors and had every test known. The only tests that were positive were that I was highly anemic and my SED rate was 69. In month 6, in addition to the fevers, an arthritic condition arose. Every joint, including ones I didn't even know I had felt as if a railroad spike and sledgehammer were being used on them continually. When I could walk, I required the use of a cane. I was 39 at the time. A second opinion doctor decided to treat the symptoms, giving me Celebrex for the arthritis. By that time, even at 105.5, I was used to the fever. Regardless, the meds affected both and within 3 days I had no pain and no fever. The doctor told me I would most likely be on Celebrex the rest of my life. Given the cost of the drug at $500 per month, when the month of samples ran out I waited to fill the 6 month prescription, just to see. The pain began to come back, but then left for good. I never filled the Rx. Official diagnosis was FUO.

11 years later, I got another stone stuck and got jaundiced. I wasn't aware that without a gallbladder I could even get stones. It was a primary biliary stone. It was removed via ERCP and a stent placed. Beyond the complications of 1000+ cc's of fluid going in per day via IV and only 300 coming out causing CHF like symptoms, all was pretty much ok. I did warn everyone who would listen and even doctors that wouldn't, about what happened when the last stent was removed, hoping to avoid a repeat. I really didn't want to call my siblings again and tell them goodbye again.

The stent was removed, and while doing so, two more stones waiting behind it were removed as well. In addition, a biopsy was taken of the Ampulla as it was red and inflamed. True to history, fevers of 102.5 began almost immediately, as well as beginnings of jaundice. The GI doctor (not the same as first time) related he had "heard" me, but essentially had dismissed my concerns. He immediately put me on Cipro and Flagyl and sent me to Infectious Disease. 14 days on antibiotics and nothing was living in my gut, and I felt like a scrubbed stainless steel pot.

The biopsy was negative, and now 1/2 way through a month before my next appointment where the GI wants to setup an Endoscopic Ultrasound.

My questions are 1) what, if anything, are they looking for besides cancer of the ampulla? 2) Could the poking of the ultrasound equipment incite a new infection / fevers? 3) How in the world can 3 stones form in the common bile duct when there is no sphincter muscle to give the bile time to back up and crystallize? And any other thoughts...

I'm not worried, not fretting, even if it is cancerous. I just want to know.

Thanks.

[bluewater22000]

Thank you for your reply! I will include in my conversations with the doctors. For it to be SOD, though, do I not have to have a functioning sphincter? I was told by the GI, that with two sets of stones getting stuck, I'd had a "sphincterectomy".

[Paderla Anitha, DNB]

Hi, your symptoms could also be due to sphincter of Oddi dysfunction (SOD), which is frequently a challenge. SOD is divided into three categories depending on other factors such as dilation of the common bile duct and documentation of abnormal liver function tests associated with the painful episodes.  You will notice that other reasons for the pain must first be excluded. This typically requires upper endoscopy, imaging such as a CT and/or MRCP to start. Your GI doc will first focus on the other possibilities and attempt to exclude them before a diagnosis of SOD could be made. Please discuss this with your doctor am sure he will provide further assistance. Regards.