Unexplained pain in right side and abdomin

Hi Everyone

I had DS in Michigan with Dr. Lutrykowski in Nov 2007.  I have been pretty healthy until April of 2015.  It started as a pain in my upper right side, I have been to 3 different Dr with no answers.  They said it appears to be an enlarged bile duct, but can get a scope up there to see what it is. So they are monitoring my blood for liver function and doing Ultra sounds.  They don't want to do any invasive procedure to see what it is.  I have gastroenterologist who says it is muscle pain, a pain management Dr who says it is nerve pain and has me on Lyrica which does nothing.  When it starts to act up the only thing that helps is Morphine injections or Percocet. Over the past few weeks everytime I eat I get severe pain which starts in the upper right side but moves down to the lower abdomin and I bloat out like I am 10 mths pregnant.  I take GasX which helps a bit but the pain is excruciating. I have been to the ER and they just give me a shot and then percocets to take home.  Today it was so bad I was doubled over at my desk at work, I took 2 percocets which did nothing. I managed to make it home crying in pain all the way.  I passed a little gas which helped a bit, but the pain is still there.  After reading some information from other DS patients I am now thinking maybe I have a bowel obstruction.

Has anyone experienced the same thing, and if so what did you do.  It is hard because there are no Dr that are familiar with the DS procedure.

Suggest you go to the er of a hospital familiar with WLS. I find the others just do not have a clue. Also make sure the gastro guy you are seeing understands wls. Perhaps be referred to a centre thaqt is familiar with DS

Sorry to hear you are having pain.

There was another person on this forum who had the DS a few years ago. I just searched the user name PatXYZ. In her signature it says, "I had OHIP approved Duodenal Switch surgery with Dr. Dennis Hong at St. Joseph's Hamilton on March 7th, 2012. Want more information on the DS in Ontario? Send me a private message!" Also in that post, she shares her email address. I tried to share it here but it displays as email address protected. I will pm you with it.

She may be a good resource/contact to have.

Good luck!

Tammy :)

Your post is extremely timely as I've just been through a very similar situation myself. I'm almost 10 years post-op RNY and ended up having emergency surgery less than a week ago.  I will post with details shortly, but I will say that simply treating it with pain meds isn't going to help, if it's anything like my issue.

First, you need a CT scan with contrast right away and as yucky as it sounds (and is, trust me omg), you need a CT scan with rectal contrast. This is the only way they can get a true look at your insides to see what's going on in there. Please don't let them dismiss your concerns - this won't go away and can be dangerous if untreated. You may indeed have a bowel obstruction, but they need to find out why it's obstructed. I had a bowel obstruction in September 2012 which righted itself with the help of an ng tube inserted for a week, but it wasn't truly "fixed" - it was a temporary bandaid unfortunately.

Let us know how you're making out and feel free to PM me if I can help.

Karen

Hi Karen

What were your symptoms, I have constant pain, it gets worse after I eat. I just saw a pain specialist and he keeps saying it is muscle pain. I don't agree and try to tell him I don't agree, and he just doesn't listen.  He said if it was an obstruction I would be vomiting. I do wake up in the middle of the night sometimes with the task of bile in my mouth and need to throw up, but nothing happens.

I went to a specialist at St Mikes to see if they could scope me, but he said because of the DS there is no way to get to my bile duct which is what he believes might be the problem as it is enlarged.  He has ordered an MRI for my abdomen to see if there is a kinked intestine or blocked bowl. He also wants to monitor my liver to see if the enlarged bile duct is affecting it.  Yearly ultrasound and blood work 2 to 3 times a year.  He is transferring me back to my original Gastroenterologist but the requistion is no where to be found.

I have been going to the washroom, but not too much, and get severe bloating and gas pains.  I am so frustrated at this point that I am getting depressed, I already am bi-polar so this does not help.

Can you share your situation with me to see if we are having the same issues.

Thanks

Susan

Hi Susan,

I'm so sorry to hear about what you're going through.

When I went to the ER on December 11 I presented as having a bowel obstruction. I'd had one before and the symptoms were pretty much identical - severe bloating/stomach distention, pain that was constant but also increased in waves which felt to me like extreme gas pain, not able to poop or even pass gas, some nausea - not sure if due to obstruction or pain or both. I had taken some lactulose at home shortly after dinner on the 10th in hopes that I was simply constipated. After arriving at the ER at 1 AM, my bowels finally moved a few hours later, leading the doctors to believe that the obstruction had, at least partially, righted itself. CT scan with contrast and subsequent CT scan with rectal contrast showed that I did have a partial obstruction and very twisty, "corkscrewed" guts. They sent me home.

I went back to the ER on December 13, repeated the same CT scans to see if anything had changed/worsened - the pain was pretty terrible by this point. I was exceptionally fortunate that the general surgeon on-call had actually been trained in bariatric surgeries at the Mayo Clinic during his internship. I am so grateful that he was on duty - at least he would know what was "normal" for my abnormal rearranged guts, and what he saw was definitely not normal. He also had the foresight to consult with my RNY surgeon from 10 years ago, who advised him that when I had RNY they configured the direction of the small intestine differently than they do today. My small intestine had passed through a surgically created opening, causing it to become herniated and pressed down so hard on my bowel that 1/2 of my colon had stretched to the size of a football, and they removed that 1/2.

I understand the runaround you're getting. Even myself, a 10 year vet who is extremely knowledgeable and up to date on bariatrics, allowed them to send me home that first night. lol  Please, if you feel you can manage it, go to the ER. Tell them you believe you have a bowel obstruction and that you've had abdominal surgery 9 years ago, have rearranged guts due to weight loss surgery. If they ask if you had RNY, tell them no, but a very similar surgery involving rearrangement of the intestines. Dependant on the hospital you go to, you may be able to request to have a bariatric surgeon review your case (not sure where you live, sorry). CT scans with contrast are the best tool for diagnosis of what's going on in there.

You take care and sincerely hope that you get some long-awaited answers and a solution to this terrible issue.

Karen xo

Sorry, meant to also mention:

If you still have your gallbladder, that could very well also be the cause of the troubles you're having. No, they can't effectively scope you, that's correct.  But that same CT scan can let them look at your ducts as well.

K.

My Gallbladder and Appendix are both gone.  I had a CT scan it showed an enlarge bile duct. I am waiting for the MRI request to go through maybe that will actually show them something is wrong.

Thanks for sharing your story with me.  I always show the the card my DS surgeon gave me explaining how my innards not look after surgery. I never even thought of asking them to contact the surgeon. He is in Michigan but I know he is always available for a consult, that is what he told me when I had my surgery.

He also mentioned that some Drs get their noses out of joint because they don't like to be told how to deal with a medical issue. I guess it is an ego thing.

It might not hurt to contact Dr. L. and let him know what's going on and that a Canadian doctor may be contacting him - that way he'll have your file on hand should they choose to consult with him. I'm sure some doctors feel some sort of ego-slight, but the reality is that we simply don't have "normal" anatomy and since he's the expert, for F sakes, consult with him! ;)

Please keep in touch, Sue - I'm happy to help any way I can.

Karen xo

At the beginning of December I started having pain starting just below my bra that radiated up my chest and down my arms.  The attacks were excruciating and happened about an hour after eating anything.  My family doctor had me take a muscle relaxer an hour before eating and a Zantac with my meals.

I was very skeptical that this was muscle pain, but the muscle relaxers did work.  I am RNY and have my gallbladder.  I was sure that I had something else wrong.