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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for gall stones and umbilical hernia

Answered by
Dr. Iven Romic Rommstein

General Surgeon

Practicing since :2008

Answered : 13166 Questions

Posted on Mon, 28 Nov 2016 in Abdominal Pain
Question: Chiross patient with recent hospitalization for pancreatic pseudo cyst blocking bile duct had stent removed where they found infection in pancreas (probably caused by stent). Two other stents were inserted, one for infection one for bile duct (oct 26). Taking cipro. After violent coughing attack, acute pain in mid section, could not get out of bed, sweating and cold and clammy, some vomiting. Dry mouth and no appetite for weeks. Also confirmed large gall stones and large umbilical hernia. Bilirubin was 23, now 3.
Answered by Dr. Iven Romic Rommstein 25 minutes later
Brief Answer:
surgery requied

Detailed Answer:
Hi and welcome.
Considering all these, it would be best to perform surgical procedure to solve both bile duct stones and pancreas psudocyst. Otherwise, there is a risk of serious complications such as necrotic pancreatitis or liver failure. It seems like there was alreay pancreatitis and cholangitis which are serious infection and recurrence of these infections may be very serious,even fatal. It is required to di surgical exploration of common bile duct, cholecystectomy and cystogastrotomy to achieve drainage of the cyst and clearing out the bile duct from stones. This surgery may have some risks, but stents inserting may not be sufficient and it obviously doenst solve the issue, So you should find experienced hepatobilliary suregon if you ask me. Wish you good health. Regards
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Iven Romic Rommstein 25 minutes later
The stent was successful in shrinking the cyst where it was no longer dreamed an issue. There are no stones in the bile duct and a stent was inserted on October 26. Could the infection they found in his pancreas on October 26 cause the symptoms of dry mouth, vomiting etc. even if taking cipro for over a week.
Answered by Dr. Iven Romic Rommstein 8 hours later
Brief Answer:

Detailed Answer:
Yes, this is probably caused by infection and if we are talking about cholangitis then it may take even 3-4 weeks till complete resolution of infection. I would add another antibiotic,such as metronidazole or clyndamicin and if there is no improvement after2 weeks,it would be good to repeat ERCP or CT biligraphy.
Above answer was peer-reviewed by : Dr. Vaishalee Punj

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