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    Suggest treatment for back pain after gall bladder surgery

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Posted on Tue, 25 Nov 2014 in Medicines and Side Effects
Question: Had gallbladder surgery in June; was having back pain on right side before hand and after, which ended up being an ulcer. Took Dexilant for four months until October, and a second upper GI showed ulcer had heeled. Just after that upper G began experiencing pain near gallbladder site and very loose stools and passing smelly gas. I had CT w/contrast, CT without contrast, sonogram done on my stomach and MR Enterography on my liver, small intestines, pancreas and bile ducts in early July and all came back negative and so did my blood work. I do have Crohn's so my GI doctor says I may be in a flare but without the blood work to show for it. I'm on prednisone and have been for a few days but still having same loose stool and smelly gas, along with pain near where my gallbladder was. GI dr. said we wouldn't need to repeat the scans and testing since we just had it done in July. Any idea if this sounds like a Crohn's attack? My GI doctor said it may be a flare since I'm bridging between Humira (stopped it two months ago) and just started on Entivyo. Only had 3 treatments of Entivyo and it has been 6 weeks since I've been on it. GI doctor said it takes about 10 weeks to get full affect.

FORGOT TO MENTION: My GI doctor said it may be a flare since I'm bridging between Humira (stopped it two months ago) and just started on Entivyo. Only had 3 treatments of Entivyo and it has been 6 weeks since I've been on it. GI doctor said it takes about 10 weeks to get full affect.

Asked by Me , 0 minutes ago
doctor
Answered by Dr. Prasanna Heijebu 3 hours later
Brief Answer:
Flare of Crohns is most likely.

Detailed Answer:
Hi Sir,

I understand your concern.

The current symptoms in your case are most likely to be a Flare of Crohn's
disease.

This watery loose stool with smelling gas is a typical feature of Crohn's flare.

This is not related to healed ulcer nor gall bladder removal.

The flare might have been precipitated by the ulcer and the surgical stress you where imposed upon.

Prednisolone is a good choice drug,but since you are bridging between Humira and Entivyo,it will take apprx for the full effect to take on.

You do not need another set of investigations right now.

You can continue prednisolone along with Entivyo for sometime until the flare is completely controlled.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Prasanna Heijebu 48 hours later
What about the pain I'm having on right side near gallbladder. Could a Crohn's flare make that part hurt after I eat? I just want to make sure I'm not dealing with an absess or narrowing of bile duct. I did have an MR Enterography that showed nothing wrong or any absess but I don't know how quickly it can show up.
doctor
Answered by Dr. Prasanna Heijebu 6 hours later
Brief Answer:
A CT abdomen can be taken for a safer rule out.

Detailed Answer:
Hi Sir,

Welcome back.

The pain in the area of gall bladder could be a part of Crohn's disease as well as a sequel of post operative Cholecystectomy.

But since most of your investigations including MR enterography came out normal,
there is nothing much to worry.

This could be a functional pain and will subside on its own.

But having said that , an abscess has to be rule out with certainty.

For this I advise you to have fresh CT abdomen without contrast ,since you had your earlier scan in July and 4 months have elapsed since then.

A CT scan is more accurate than MR Enterography to rule out post cholecystectomy complications.

A CT abdomen at this stage can reliably distinguish between the causes of post cholecystectomy and Crohn's disease flare up.

It can also accurately distinguish between an abscess and bile duct stricture secondary to any new stone formation in the residual ducts.

I would like to conclude that its safe to have fresh CT scan to rule out the above with possibilities, even though its mandate.
The choice is left to you.

Thank you.


Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Answered by
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Dr. Prasanna Heijebu

General & Family Physician

Practicing since :2010

Answered : 1422 Questions

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