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Digestive Disorders

Billiary Disease in our son

09/10/2007

Question:

Our son had his gallbladder removed 1 1/2 years ago (it ws only working @ 30%) Now he is having abdominal pains vomiting bile has lost 25 lbs in about 2 months. He is in the Army and they have sent him to a civilian Gastro spec. who put him on symax and wants to do another scope. He believes that his bile ducts are blocked or restricted. He said that there is a Dr. in Dallas that can do a special procedure to cut some muscle that might be blocked if the implanting of stents does not work. Our question is how long does it take for pancreatitis to start setting in (if it has not done so yet?

Answer:

I am sorry to learn of these problems. It is a little difficult for me to follow everything you said; I am sure that it is a complicated situation and it is hard to get everything down.

With the very limited history, I do not think it unreasonable to have a GI doc do an ERCP (this is the scope test in which a roadmap of the bile ducts is made by injecting contrast into the biliary tree). It is possible that your son has new stones in the common bile duct. The ERCP test is a great way of looking at this. You did not mention if he had stones prior (leading to the removal of the gallbladder).

You also did not tell us about stents placed, at some point. Then you mention about pancreatitis. I am sorry, but this is too confusing for me to give you a reliable answer. The "muscle" needing to be cut is called the sphincter of Oddi. It is a small muscle that controls the flow of bile and pancreatic juice into the duodenum. It is very normal to cut this muscle during an ERCP.

If your question entails about acute pancreatitis following ERCP, this is a know complication of the procedure. When it does occur, you usually see it very shortly following the procedure; within hours to a day. The frequency somewhat depends upon the person doing the procedure, how aggressive they are in doing the procedure, as well as the particular anatomy of the pancreas, the pancreatic duct, amongst other things. However, with a loss of 25 pounds, and vomiting bile, it would seem to me that the small risk of post-ERCP pancreatitis, may very well be worth it.

In addition, I would imagine that a CT scan has been obtained.

I am sorry, but this sounds like a complicated story and I would not anticipate that you know all the details. Unfortunately, I cannot follow this well enough to be of more help.

Best regards.

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Response by:

Steven  M Rudich, MD, PhD, FACS Steven M Rudich, MD, PhD, FACS
Formerly
Professor of Surgery, Director of Liver Transplat and Hepatobiliary Surgery
College of Medicine
University of Cincinnati