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Had csection delivery. Having stomach pain. Done USG and MRI

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General Surgeon
Practicing since : 2008
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My wife (age 28) has csection delivery on 10th July. post two weeks of that she suddenly felt a severe pain starting mid back and then to stomach. Such pain repeated thereafter for 4 times. Bscopan injection worked once and once vomeran injection. Although her USG at the begining of pregnancy showed no gallstone now recent MRI scan shows the same. Please suggest how to determine whether this is a gallstone pain. What medicine she should take for pain relief. Please suggest line of treament keeping in mind she just had one operation and breastfeeding.
Posted Tue, 10 Sep 2013 in Abdominal Pain
Answered by Dr. Grzegorz Stanko 37 minutes later
Brief Answer:
Peptic ulcer.

Detailed Answer:

Thank you for the query.

Most probable reason of such pain (as gallstones are definitely ruled out) is peptic ulcer. Surgery is a kind of stress which can indicate stomach wound (an ulcer). It is called stress ulcer. Neither ultrasound or MRI wont diagnose such ulcer as it is usually invisible for this tests. Also blood work is negative in case of peptic ulcer.
Typical peptic ulcer symptoms are upper middle abdominal pain (can be a back pain as well), nausea. The pain is usually triggered by meals.

Gallstones do not appear in a short time. It needs to take years for its creation. So this condition is ruled out.

In some cases such symptoms can be also present with breastfeeding if the ulcer might be life threatening). In case of mild ulcers or stomach inflammation, soft diet can be the only treatment.

To help with the pain, hot bath can be helpful. Other medicines should bot be used during breastfeeding.

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Had csection delivery. Having stomach pain. Done USG and MRI 31 minutes later
You mean to say this is not gallstone attack which arrives suddenly. I heard pregnancy is correlated with gallstone formation. Urine culture report shows "no growth" therefore infection may not be the reason.

We are not sure how to detect whether it is for gallstone or ulcer. Can csection surgery lead to any such ulcer formation?
Answered by Dr. Grzegorz Stanko 6 hours later
Brief Answer:
Gallstones seems to be ruled out by MRI.

Detailed Answer:
Typical gallstones pain starts after fatty food, spicy food or alcohol. It appears in the upper right abdomen and occasionally radiates to the back. Nausea and vomiting is very often present.
Pregnancy is correlated with gallstones formation indeed. It is also associated with many others issues what does not mean that this conditions will appear.

You have mentioned that MRI were done recently. This is enough to rule gallstones out (even regular ultrasound which is less accurate than MRI can do that as well). So no further "detection is necessary".

But if you are not certain about gallstones the best way is to have regular abdominal ultrasound done. If no gallstones will be present, next step is gastroscopy. This two tests will definitely tell if she suffers either from gallstones or peptic ulcer.

C-section is a surgery. Like I have mentioned before, every surgery is a great stress for human body what can lead to stress ulcer creation.

Hope this will help. Feel free to ask further questions.
Above answer was peer-reviewed by
Follow-up: Had csection delivery. Having stomach pain. Done USG and MRI 12 hours later
I was wrong writing my first mail. Actually recent MRI shows multiple small calculi in gallblader although the initial USG at the start of the pregnancy didnt show this. Is this possible to develope gallstone over the 9 month period due to pregnancy. Now please suggest the next course of treatment. Please suggest if medication is possible except any immediate surgery. We are planing to do upper adbomain USG to determine whether gallstone is there.
Answered by Dr. Grzegorz Stanko 4 hours later
Brief Answer:
Your wife has gallstones.

Detailed Answer:
Ok, so it makes things so much different.
Here are the facts: your wife has gallstones. No doubt in that. Like I have mentioned before, MRI is much more accurate than an ultrasound. So this stones could not be visible in the previous abdominal ultrasound or the stones has been created during pregnancy (it is possible).

Now, gallstones presence is the most probable reason of your wife's pain. Especially that she has small stones. Such stones like to migrate to the bile ducts what can lead to its obstruction and in some cases to acute pancreatitis.

However, it is quite common that the person which has abdominal pain has gallbladder removed and still the pain is present. Its because peptic ulcer can give similar pain and many gallstones cases are painless for years. That is why, its good to know about the stomach condition before any surgery.

Unfortunately there is no medicine which can help with the gallstones condition. Surgery is the only option. She can control the pain with diet, but it wont treat the stones.

So in conclusion:
- she has gallstones, MRI is the best test we have to detect them
- she should have gastroscopy
- she should avoid fatty foods, spicy foods, coffee, alcohol
- she should get scheduled for surgery after the breastfeeding is over

Hope this will help.
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