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Family Physician

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What causes pain below left rib cage and left shoulder?

Answered by
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3569 Questions

Posted on Mon, 18 Aug 2014 in Digestion and Bowels
Question: On XXXXXXX 23 went to bed at 2 a.m. feeling fine. Woke at 4 a.m. with severe chills. Husband came in at 8 a.m. and told him I was sick. Took me to hospital. Had pneumonia in right lung and developed sepsis within a few hours. Procalcitonin was 57.4. BP was 70/50 and had been given 4 bags of fluid without urinating. P.A. came in and had me moved to CCU where a central line was started. Spent three days in CCU and then 4 in regular room. Right lung became much worse. Was given 3 broad spectrum antibiotics thru central line. Went in on Monday. Saturday developed severe left shoulder and arm pain. X-rays of shoulder showed no problem. Went home Saturday evening. Pain in shoulder, arm and hand continued. About a week ago pain under left rib cage began. Have been weak and tired. Sleeping 20 plus hours a day. Two week follow up x-Ray showed significant improvement in right lung. Doctor said just do what I can tolerate. Too weak to do anything. Pain in left upper quadrant just under ribs is getting worse. No fever, O2 is 98%, BP is ok but pain and weakness continue. RBC was low in hospital as was protein. Pneumonia was in right lung. Am 61 years old - never smoked or drank. Have DGD and Chronic Pancreatitis for which I have ERCP with stent exchange every 6 weeks. Had mass on liver (left lobe) when I was 36. Removed mass and gallbladder during surgery. Rerouted common bile duct after gallbladder removed. Mass on liver was hemangioma. Had lost so much weight doc felt sure I had cancer so pulled everything out but no cancer. Did good for a couple of years and then began to loose weight and vomit after eating. Significant weight loss. Was finally sent to GI who did ERCP and found large amount of neurotic tissue and discovered pancreatic duct was also stenosed. Opened common bile duct and pancreatic duct and put stent in Pancreatic duct. Told me the long time it took to diagnose problem and amount of neurotic tissue was how people get pancreatic cancer. The pain from pancreas is more in center of upper abdomen and into back on right side. This pain is higher and on left side under ribs. Pain doc felt they had caused problem with neck when putting in central line. He did a neurotomy from C-2 thru C-5. This has not helped shoulder and arm pain nor weakness in left arm and hand. Procedure was done 10 days ago. Am concerned about pain on left side and continued weakness. Don't know if this is just to be expected or if something else is wrong. Believe pneumonia was caused by aspiration although had not been vomiting. ERCP had been done on Wednesday before got sick on Monday. Docs did not believe it was related to ERCP.
Should I be concerned about upper left quadrant pain or just continue to rest and expect to get stronger with time. Last thing I want to do is go back to hospital.
Answered by Dr. Suresh Heijebu 9 hours later
Brief Answer:

Detailed Answer:
Hi Madam,
I have gone through your query and understand your concern.

As per your clinical history the pain below your left rib cage and left shoulder has most likely originated in the setting of "Acute Necrotising Pancreatitis".This form of pancreatitis is most severe and would leave the patient quite debilitated.

You are currently experiencing this state.To your misfortune,you had super imposed lung infection-pneumonia.Hence the pain worsened and your general body condition deteorated.

Past history of liver surgery for Hemangioma and gall bladder is not related to your current pain disorder.So please rule this out of your mind.Also pain is not related to ERCP procedure.

Gross metabolic disturbances arising out of lung infection worsened your clinical picture.

But now since your lung infection was brought into control with intensive management and a Neurotomy was performed high through c2 and c5,you can completely rest assure as this pain will now progressively diminish in intensity and would disappear sooner.

Neurotomy is known to offer excellent permanent pain relief in majority of pain patients.

I would also like to stress the fact that you are currently on a combination of Opioids -Fentanyl and Hydrocodone to control pain.These drugs are quite effective and they produce dramatic pain relief as well.

So madam i strongly believe that you will improve and get better with time ,as you have so far received an updated and standard protocol of treatment from your doctors.

Just continue with your current treatment modalty and have a stress free and good dietary life style.Do not loose self confidence.

I wish and hope my feedback to you is useful and convincing.
Please feel free to ask further queries,i shall answer,
kindly take time to rate my answers as it helps to improve my presentation.
Thank you,
Wish you a good health ahead,
With regards,
Above answer was peer-reviewed by : Dr. Yogesh D

The User accepted the expert's answer

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