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Forum Name: Liver Diseases

Question: sphincter of oddi dysfunction


 katrinka - Fri Oct 30, 2009 5:06 am

In May 2009 I underwent an ERCP due to upper right quadrant pain similar to pain with a gallbladder attack. I had my gallbladder out in 2001. Prior to the ERCP, I had an abdomen CT scan which was normal, sonogram which was also normal, liver function tests normal except slightly elevated alkaline phosphatase. I had an open MRI (can't handle closed ones) and it showed dilated bile duct with possible stone. The ERCP showed no stones and ducts were all fine. However, mamometry done on pancreatic sphincter showed pressure exceeding 60 mm Hg. A sphincterectomy was performed. I am now having the same terrible pain. I have been to the ER but only get pain relief and then am sent home. My GI doc doesn't want to help as he thinks besides the pain all my tests are normal. I think I need another ERCP to see if the site has closed over with scar tissue and needs to be reopened. Does anyone have any ideas what I can do? Can scar tissue form this quickly and in the amount it would take to close off the opening? I am in so much pain and feel that my doctor is not listening.

Katrinka
 Dr.M.Aroon kamath - Fri Oct 30, 2009 7:53 pm

User avatar Hi,
Symptoms of sphincter of Oddi dysfunction (causing postcholecystectomy syndrome) at times persist despite what appears to be adequate management(as in your case).

Why a few have persisting symptoms, is not clear.

The initial option is for your regular doctor to try various non-surgical modalities based on clinical examination and symptoms.
(it has been noted that in patients who abuse narcotics or alcohol,
management of pain is often unsatisfactory).

If all non-surgical options do not work, 'open' surgery (sphincteroplasty) may be considered.

Good luck!
 katrinka - Sat Oct 31, 2009 10:06 am

I have been to several doctors regarding this situation since I have put in my post. I saw three physicians yesterday. I went to a Pain Management Specialist, my gastroenterologist, and my internist. All are baffled by my continued pain. I have been placed on levsin to see if that will help ease the pain. I am on pamelor (tricyclic antidepressant for pain management). No one seems to be able to narrow down what else could be causing me the same pain I had prior to the ERCP. I also can't seem to get an answer as to whether scar tissue would have occurred enough since the surgery to block the opening. If you have any ideas with regard to the scar tissue or suggestions as to management of my pain/condition, I would be most appreciative. Thank you.
 Dr.M.Aroon kamath - Sun Nov 01, 2009 8:27 pm

User avatar Hi,
It is almost impossible for anyone to predict how much of scar tissue might or might not have formed.
sphincteroplasty is done hoping that the opening at the papilla of Vater remains patent following the procedure.
Best wishes!
 katrinka - Mon Nov 09, 2009 8:14 am

I just had another ERCP done - the bilary duct was somewhat closed and so a sphincterectomy was done. I am not really feeling any better. There was no scar tissue in the pancreatic duct, no pressure, and it was still open. So at least that was good news. I am hoping this procedure will help with the bilary duct as well. I am taking Levsin to try and help with the spasms. I have spasms down my esophagus and into my chest and then stabbing pain in the upper right quadrant. Is there something better that I might be able to take for the pain? I am on a low-fat diet. Thanks.
 Dr.M.Aroon kamath - Sat Nov 21, 2009 11:51 am

User avatar Hi,
As i wrote to you earlier, sphincterotomy is done hoping that the papilla of Vater is widened and remains open.Unfortunately, like any other surgical procedure, it also fails and sometimes papillary stenosis results.

I am glad that a re-sphincterotomy was done.About medications for your pain, only your doctor would be in a position to assess the degree of your pain and tailor the drug dosage or change over to another drug. Best wishes!

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