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Suggest remedy for severe abdominal muscle spasms post CBD stent removal

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Posted on Tue, 24 Nov 2015
Question: Had a stent placed in CBD during ERCP- now having terrible spasms should i have the stent removed?
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Answered by Dr. Klerida Shehu (2 hours later)
Brief Answer:
Please follow...

Detailed Answer:
Hi and thank you for asking!

You are reporting to have done ERCP with stent, and now you have terrible spasms.

First of all you should do abdominal ultrasound or EUS/Ct scan to get information about the position of the stent. If it is in the right position and CBD is clean( without biliary sludge) than there is no need to remove your stent.

I review your medical history in HCM and I noticed that you have done pancreatitis after the last ERCP procedure.

Most probably your symptoms are related with reactivation of pancreatitis.
This is why I suggest to do :
- blood lipase level
- blood work
- PCR
- abdominal ultrasound plus EUS(upper endoscopy ultrasound)

Meantime I suggest to :
- avoid fatty meal
- use Prilosec plus antispasmodic drugs like butyscopolamin.
- consult immediately your gastroenterologist surgeon.

Wish you all the best!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Klerida Shehu (4 hours later)
Yes in RUQ- have had these before but very infrequent. Doc said my duct was wide open had a sphincterotomy done 14 months ago- but he inserted the stent to rule out this being a cause of my epigastric pain- these episodes occur every year or so and last about a month
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Answered by Dr. Klerida Shehu (18 hours later)
Brief Answer:
Please find below explanations

Detailed Answer:
Hi back
1.I need to know if you have elevated liver panel or lipaze levele during the pain time?

2.If all the exams are normal during the pain time than you can disucuss with your doctor about another diagnosis to explain your symptoms.

IBS is another issue that can explain your upper quadrant pain.

3.I need to know if you have bowel movement issues especially during the pain time?

Wish you all the best!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Klerida Shehu (3 hours later)
All labs NL pre post procedure LFT's and A/L w/o change.no change inSx's with BM - but mild relief of post procedure epigastric pain. After the first and only sphincterotomy on CBD which was done 14 months ago i would get this spasm which lasts about 5 to 10 seconds its like a painful cramp with pulling in mid epigastric or RUQ area after drinking soda or having potato chips maybe once per month. After This last ercp with stent placement that was done 60 hours ago - these spasms are about 10-15 per day. But slowing done as i increase my food intake since procedure. i had an EUS of pancreas which revealed " minimal amounts of fat in pancreas otherwise NL no signs of acute or chronic pancreatitis" he also did an egd prior to ercp and removed 2/3 of a 3 cm polyp at the pyloric valve which was not there 14 mo ago. He inserted the stent even though my CBD was open to prevent closure and eliminate SOD as a source of my pain which occurs about every year and can last dorbupbro 3 weeks. The spasms this frequently are new my concern was did ths stent cause increased bile flow and these increased spasms- the initial epigastric pain is slowing down each day after procedure but is still there which is the same as i had with other procedures. He said its a " short stent" if that falls out is it dangerous or willnit just oass in stool- thx
doctor
Answered by Dr. Klerida Shehu (16 hours later)
Brief Answer:
Please follow...

Detailed Answer:
Hi back,

If your stent falls out than it is complicated with blockage of biliary duct , intestinal perforation, bleeding etc. But if your stent is short and plastic than the complications are less serious.

You are reporting to have only 60 hours after the procedure and that your spasm are slowing down after increased food intake.

To my opinion you should wait a couple of days till your GI track start to function normally to feel improvement of your symptoms.

Wish you all the best
DR.Klerida


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Klerida Shehu (12 hours later)
What i notice is during and just after i eat these spasms occur in midepigastric region- followed by a burning sensation. Very painful. Then my bowel sounds increase almost like a churning. Even after i had the gastrograffin when the ct was done this am- 1 hour later this horrific burning was present. The GI specialist wants to remove the 6mm plastic stent in the cbd bc he sees no advantage to it being there as the duct was wide open at time of ercp, and he feels it may be irritating my duodenum. He placed the stent to see if he could alleviate future problems- i still dont understand his rationale- but that being said- i am becoming overwhelmingly concerned about my symptoms - nobody seems to think theyre dangerous- but they are ruining my ability to fxn optimally- if visceral hypersensitivity is the answer why once a year for 3 weeks- if sod was the answer why symptomatic with a " wide open cbd"- sorry im painstakingly trying to achieve an answer i appreciate your help
doctor
Answered by Dr. Klerida Shehu (19 hours later)
Brief Answer:
Please follow the suggestions below.

Detailed Answer:
Hi and thank for giving more of your medical data.

After review all your medical data I have some other questions like :

1. You are reporting that only 3 weeks per year you have abdominal pain.
It is always at the same month or season? Are your symptoms related with a stressful situation?Have you done allergic food test.

To my opinion your symptoms are related with functional disorders of GI tract.

From what you are describing it seems to be related with a spastic situation of GI tract and not only from CBD.
I am waiting your answer.
All the best.
Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Klerida Shehu (10 hours later)
Thank you the GI surgeon removed the stent today via endoscopy said there was no indication for its placement as CBD was completely open at ercp. Which correlates with your previous response. He also reccomended elavil 10 mg at bedtime- he believes like you the timing is not superfluous but is related to something allergen induced. I do have multiple food hypersensitivities- dairy gluten MSG to name a few. I have always turned my head to IBS visceral hypersensitivity
doctor
Answered by Dr. Klerida Shehu (6 hours later)
Brief Answer:
Please follow...

Detailed Answer:
Hi back my dear

IBS is closely related with gluten sensitivity.So your suspect for IBS is not wrong.

At this situation I recommend to do full panel food hypersensitivity test and start a gluten free diet.
Avoiding gluten will help you to improve symptoms even if they are from IBS.

Wish you fast recovery!

Best regards
Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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Suggest remedy for severe abdominal muscle spasms post CBD stent removal

Brief Answer: Please follow... Detailed Answer: Hi and thank you for asking! You are reporting to have done ERCP with stent, and now you have terrible spasms. First of all you should do abdominal ultrasound or EUS/Ct scan to get information about the position of the stent. If it is in the right position and CBD is clean( without biliary sludge) than there is no need to remove your stent. I review your medical history in HCM and I noticed that you have done pancreatitis after the last ERCP procedure. Most probably your symptoms are related with reactivation of pancreatitis. This is why I suggest to do : - blood lipase level - blood work - PCR - abdominal ultrasound plus EUS(upper endoscopy ultrasound) Meantime I suggest to : - avoid fatty meal - use Prilosec plus antispasmodic drugs like butyscopolamin. - consult immediately your gastroenterologist surgeon. Wish you all the best! Dr.Klerida