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Gastroenterology  (Expert Forum)
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Complications following Gall Bladder Surgery
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
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MedHelp Member's Question

Complications following Gall Bladder Surgery

by mwl, Apr 04, 2003 12:00AM
On Tuesday, April 1, my wife had laparoscopic gall bladder surgery. The surgery seemed to go well. After a morning operation we were back home about mid-afternoon. Later that evening her pain increased and kept increasing until about 1:00 AM Wednesday morning she could stand it no longer even with a dose of 2 Vicodin tablets. I took her to the hospital ER and they began trying to find out why. Later that day we were told that the clip on the bile duct had slipped and bile was leaking into her abdomen. Only large amounts of morphine could relieve her pain. Finally, late Thursday afternoon a stint (tube?) was placed into the bottom of her bile duct to drain the bile into the intestine. A doctor did this by going down through the mouth, throat, and stomach. Friday morning she felt somewhat better until about noon. She began to hurt again and the nurse gave her as much morphine as the doctor had ordered and the pain was not relieved. The doctor arrived, increased her morphine, and ordered blood tests. The blood tests revealed an irritated pancreas which the doctor agreed is very painful. My wife is now on an automatic morphine drip (push button, get drug) and the doctor states that a day or two will settle the pancreas down. So my wife remains in the hospital all doped up on morphine so she can stand the pain.



I've related this to the best of my layman's ability. Do you see anything wrong with the doctor's treatment? Why did the bile duct clip slip? The surgeon claims it just happens in a small percentage of cases and nothing can be done to prevent it. Was a mistake possibly made? My wife has been in serious pain and on morphine for the better part of 3 days now when we expected a simple out-patient procedure and a quick recovery. Was she just unlucky? I also have an issue with the delay in installing the stint about 36 hours after the problem was found. Supposedly, the doctor was "tied up". Should this have been given higher priority?



Your honest opinion would be sincerely appreciated. I am not looking for a law suit. I only wish to get a second opinion about this course of treatment and the problems my wife has encountered. She has had a very rough week.
Doctor's Answer

by Kevin Pho, MD, Apr 05, 2003 12:00AM
Hello - thanks for asking your question.



Unfortunately bile leak is one of the complications of cholecystectomy.  It is more common in laparoscopic procedures.  Studies suggest the incidence ranging from 0.6 to 2.2 percent.  Symptoms include abdominal pain such as your wife is experiencing.  



It sounds like an ERCP was performed to determine the source o the leak and placement of the stent.  In those without complications, stents can be removed after four to six weeks.  



Unfortunately it sounds like the irritated pancreas is possibly from the ERCP.  The incidence of this complication is approximately 5 percent.  Most cases of this complication can be treated with bowel rest and intravenous fluids.  If the pancreatitis is severe, then the hospital course may be lengthened.  If there continues to be irritation of the pancreas, then a repeat ERCP may need to be performed for further evaluation.  



It seems to me that your wife had an unlikely complication of the cholecystectomy (bile duct leak, approximately 0.6 to 2 percent), and to repair this, had an unlikely complication of ERCP (pancreatitis, approximately 5 percent).  These possible risks should have been explained prior to each procedure.



The current management (bowel rest and IV fluids) is reasonable.  As for the placement of the stent and ERCP, that was a reasonable procedure to do once the diganosis of bile duct leak was made.



Followup with a gastroenterologist is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (8)

by TazLady, Apr 05, 2003 12:00AM
I had to write because your wifes problem sounds very familar.  I had extreme pain after my gallbladder operation too.  The surgeon droped my sac inside me and had to go "rooting" for the stones that escaped inside me and on the cutting room floor.  I was sent home that same day but the nurse in the recovery out patient room kept telling my husband due to what happened I should be in the hospital.  Of course the surgeon disagreed.



Well after 2 weeks of extreme pain I kept calling the surgeon telling him that the pain meds he gave me weren't doing a thing for me.  He told me I wasn't managing my pain well.  After 3 months, I was referred to a GI who assessed my situation and said to me that I was nothing more than bored lonely housewife looking for attention.  He even told me 1 time in the hospital after 3 days there, that was nothing wrong with me when I came in and nothing wrong with me now, other than the fact that I was "obeese".  I was 30 pounds over weight.  And since I didn't drink, wasn't losing weight for any unseen reason, I was under forty and fat....pancreatitis wasn't suspected or even looked for.  Even after 3 ER visits in which that ER doctor woke my PCP up at 4 in the morning to tell them I was having an acute pancreatic attack.  No one belived me.



Final after more than a year later I was diagnosed with Severe Chronic Pancreatitis.  I am now sick and will be for the rest of my life, all because some stupid doctors didn't care enough to listen to what I was telling them because I didn't fit a profile and didn't believe that I knew my body better than they did.



Your wife had gallbladder surgery followed by an ERCP for palcement of the stent.  The stent will have to come out and that will require another ERCP.  In my humble opinion she had an acute pancratic attack after gallbladder surgery and most likely another after the ERCP.  Pancreatic attacks like to happen after surgerys and especially after ERCP's.  I HOPE that she only had the 1 or 2 acute attacks, and will never have another one.  It is possible.  But you should see a SPECIALIST dealing with the pancreas and don't take no for an answer regarding a referral!  It is essential that she be evaluated and seen and treated if necessary.  Believe me, you DO NOT want to have chronic pancreatitis.  



And in case no one told her yet, even after having 1 pancreatic episode there are rules she must follow for the rest of her life to help prevent other attacks.  No alcohol of any kind.  Even in cough medicines, nyquil, non alcoholc wines and beers...etc.  Pancreatitis is about 80% caused by alcohol over abuse, but as in my case and it would seem your wifes, 20% of the time it is called idiopathic, which means it can't be determined how it was caused.   But mine was from surgery and it would seem hers was too, in my hum,ble opinion.  She should eat a low fat diet now.  No more than 25-30 grams of fat a day.  No fried foods.  And of course, everyone cheats on there diet in life, even pancreatic sufferers, but it just means you will have more pain after eating that meal than usual. She should see about getting pancreatic enzymes to help reduce the amount of work the pancreas has to do.  A Fecal Fat Test will help conclude it she has any problems digesting fats which is one of the symptoms of pancreatitis.



Morphine is the only thing that helps my pain when it is so bad that I need to be admitted to the hoispital or got the ER room.  Pancreatic attacks are worse than giving birth, your wife will attest to that.  There is nothing more painful out there than a pancreatic attack. Demerol doesn't do a thing for the pain.



I have gotten advise from an attorney about recourse from my own operation and because I signed a waiver, I was told nothing could be done.  Evidently the waiver has a clause in there that something could go wrong during the operation, such as a pancreatic attack.



If your wife is in the hospital they are not letting her eat because the pancreas needs to rest to get better.  And I will tell you that for every day she spends in the hospital, it will take a week before she fully recovers.  If she's there for 5 days, expect about a 5 week recovery time before she feels energenic and recooperated.



I say none of this to scare you but to warn you of the dangers of this disease.  I hope that all goes well for her and that makes a full recovery.  Some people with only a few pancratic attacks under there belt, never have another one again.  And her amylase or lipase level wasn't that extremly high to suggest that bad of an attack.  Mine have been as high as 2000 and 5000 during an especially bad attack that kept me in the hospital for 9 days. BUt it was elevated and that is a sign, besides the fact that she was diagnosed as having this attack.



If someone had given me advice about pancreatits before it got so bad for me, I'd have been more aggressive in finding a doctor to listen to me.  But after a year, I started believeing the doctors that there was nothing wrong with me and that it was all in my head.   So I say this all to you only as a warning of what can be.  If there is anyway to prevent pancreatitis from going from the acute to chronic stage, it must be taken.



Best of luck to you both,

TazLady

PS...If you have other questions you'd like