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  • Q&A with Australian Health Practitioners

    Where do I seek further help for recurrent RUQ abdomen pain?

    Pain started Sept last year. Gastroscopy, Colonoscopy, gallbladder ultrasound and HIDA scan all unremarkable. Laparoscopy revealed gallbladder adhesions and it was removed. No pain for 3weeks. Pain returned, cyclic every 3rd day. Stomach emptying study normal. Liver enzymes mildly elevated, had been normal previously. ERCP and balloon trawl revealed debris but no stones, sphincterotomy performed during ERCP. No pain for 7 days. Now get debilitating pain every second day as regular as night follows day. Pain appears in the morning and can be before or after breakfast. I am a well controlled IDDM and have 3 monthly HBA1c checks with results around 6. I have been an insulin pumper for 14 years. On my pain free days by blood sugar always trends low. I eat regularly and weight my food and determine carbohydrate values in grams to determine my insulin Bolus requirements, so my bsl control is normally midrange. My LFT,s have now returned to normal but the pain persists. Where to now?
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  • 2

    Thanks

    A/Prof. Payal Saxena

    Gastroenterologist

    Dr Payal Saxena is a Gastroenterologist and Hepatologist appointed at Royal Prince Alfred Hospital, Prince of Wales Private Hospital and The Chris O'Brien LifeHouse. In … View Profile

    Your pain may be related to sphincter of oddi dysfunction which commonly persists after cholecystectomy and can respond to ERCP and sphincterotomy, particularly if LFTs are raised during episodes of pain. Biliary manometry can help diagnose this condition.

  • 1

    Agree

    1

    Thanks

    Anonymous

    I had ERCP, ballon trawl of bile duct and sphincterotmy late Nov   2014 and was pain free for 7 days, after which pain returned as described in my original question

  • 1

    Thanks

    A/Prof. Payal Saxena

    Gastroenterologist

    Dr Payal Saxena is a Gastroenterologist and Hepatologist appointed at Royal Prince Alfred Hospital, Prince of Wales Private Hospital and The Chris O'Brien LifeHouse. In … View Profile

    It is difficult to give an opinion about your particular case without having a full consultation, however sphincterotomies can re-stenose in up to 20% of cases post ERCP and may be the reason for return of symptoms.

     

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