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Had gall bladder removed. Having abdominal pain. Is there any treatment besides ERCP with manometry?

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Orthopaedic Surgeon
Practicing since : 1975
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I had asked a week ago about some abdominal pain I am have been having... Had my gallbladder out in Feb for Cholecystitis and small gravel. I have been pain free since. About 3-4 weeks ago I began not feeling well. If I eat I get what I call phantom gallbladder attacks within 2 hours of eating. Its RUQ pain that radiates to back. I have not been eating in fear of pain. I have lost 9lbs. 5'4" 137lbs. I have tried changing my diet and simply not eating at all. Not eating at all is the only thing that works but is not a way of life. I work as an RN and when the pain hits its hard to get through the shift. I also have occasional unexplained acidic diarrhea with some of these attacks but this as only happened on 3 occasions. Other than that no change in bowel movements. Had an ultrasound that showed 7mm common bile duct. I have an order for labs but my GI Dr. said to only go when the pain is bad because he thinks that would be our best chance of catching a liver enzyme elevation. He is questioning Sphincter of Oddi dysfunction. I have done some research and sounds like my symptoms. My question is, is there something else that this could be? If this is SOD is there any treatment besides ERCP with manometry? I have tried antispasmotics and so far no help. The pain lasts anywhere from 20mins to 4 hours. Also tender to palpation. If its SOD I have to see a different specialist due to procedure having possibilities of pancreatitis. Is there any way I could treat these symptoms without this procedure and risk of pancreatitis?
Posted Sun, 21 Oct 2012 in Abdominal Pain
Answered by Dr. Rajesh Gajwani 2 hours later
Thanks for posting your query.

After reading your symptoms, i feel that you may have developed either sphinctor of Oddi dysfunction as mentioned by your physician or there could be presence of a stone in the common bile duct as your ultrasound shows 7mm Common bile duct which is dilated and not normal.
The treatment for SOD or the stone in the duct is the same ie: ERCP (Endoscopic retrograde cholangiopancreaticography) with manometry. This is the best and the only viable treatment for the aforementioned problems.
Antispasmodic drugs give minor relief in some patients but may not be of use where surgery is required. ERCP is a safe procedure with excellent results.

I would recommend you to visit a gastroenterologist immediately and also get a CECT (contrast enhanced CT scan) done for precise diagnosis.
Meanwhile avoiding fats in diet may help in reducing the pain.

Hope you feel better soon. If there are any more queries, I'll be happy to help.
Above answer was peer-reviewed by
Follow-up: Had gall bladder removed. Having abdominal pain. Is there any treatment besides ERCP with manometry? 20 hours later
Thank you so much for your immediate reply. I keep putting off getting my liver enzyme lab draw when the pain is bad because I always feel like maybe the next time the pain may be even worse and I might miss the elevation. What happens if I get my labs drawn and the liver enzymes are not elevated? Could I still have a stone in the CBD? Could it still be Sphincter of Oddi dysfunction? I did read that in the type III of the dysfunction sometimes enzymes are not elevated. I also read that the type II of the dysfunction could mean just the Common bile duct is dilated. Is 7mm enough of an elevation to be classified as a Type II sphincter of Oddi Dysfunction. Could I have a stone in the duct that has made my duct enlarged but not raise liver enzymes? The other night the pain was so bad that I almost went to the ER. Being an RN I really hate being the patient. If the pain were to get that bad again and I ended up in the ER is there a medication or treatment that would help the intense pain? I am scared to get an ERCP and I am scared to live with this.
Answered by Dr. Rajesh Gajwani 43 minutes later

First, I would want to reassure you that ERCP is a very safe procedure with excellent results. Avoiding the procedure will only worsen your condition. You should not wait for another bad episode of pain and must act on it immediately.

As I had mentioned, CECT will give you a definite diagnosis so that you dont have to guess about what you have. All the vague guessing about you having Sphinter of Oddi dysfunction or stone in CBD needs to be confirmed and acted upon accordingly. With Contrast Enhanced CT, it will be diagnosed immediately. Please do not post pone your lab tests as well.

Yes, even if liver enzymes are not elevated in some cases, stone may be present in Common bile duct which needs to be treated.
7mm dilation is more than normal and may be Type II sphincter of Oddi dysfunction but it needs to be verified.
I would strongly recommend you to visit a gastroenterologist for examination along with your lab reports and get treated immediately as the pain can be very severe. Medication does not give sufficient relief and ERCP is the only ideal solution to your problem.
Have faith in your doctor and go ahead with the required treatment. You will feel better soon.
Above answer was peer-reviewed by
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