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Severe attack of upper back pain - Ärzteforum

Post#1 »

I recently had a severe attack of upper back pain; different from the pain I had last year when I ruptured my L5-S1 disk. It went a way in a few days, but was followed the following 3 nights by recurrent back and eventually right upper quadrant pain. I got an ultrasound which showed one, possibly two small gallstones, as well as possibly a small stone in the common duct, which is 3 mm. in diameter. All my lab tests are normal. I left a few days later for a Carribean Cruise, and survived, only suffering some frequent bloating and fullness, with no severe attacks.

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Re: Severe attack of upper back pain - Ärzteforum

Post#2 »

If the case were referred to me, I would do a lap chole with routine cholangiogram. If I found a CBD stone, I would probably be able to push it into the duodenum with a small Fogarty catheter.


Re: Severe attack of upper back pain - Ärzteforum

Post#3 »

Unfortunately, I know of no reasonable way that I can take out my own gallbladder :( None of the other surgeons that I know do routine cholangiography, or have ever done a laparoscopic CBDE. I don't particularly relish the idea of an ERCP or an open CBDE. I'll probably repeat the ultrasound to see if the stone is gone; I'm hoping that the CBD stone wasn't real, or that it has passed spontaneously anyway. The question I am posing is this: How do others feel about surgery on themselves? Would you go far away where nobody knows you, or stay at home? When I had my back operated on, I felt comfortable because I trusted the surgeon and knew he was good. My problem is that I have seen all the other surgeons do lap choles, and that is why I am scared. Of course, that is probably silly, since their results are acceptable, though, again, some of their patients come back later.

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Re: Severe attack of upper back pain - Ärzteforum

Post#4 »

Your major problem is in finding a SURGEON who does a half decent ERCP. This procedure should generally be done by surgeons, and if it isn't, surgeons should learn how to do it properly. I can't understand the general atmosphere of "ANTI-ERCP" in the States, and the fostering of laparoscopic ECBD, which in my humble opinion is a dead end, haunted by a very few talented afficionados who can pull this baby off efficiently without a learning curve that leaves major league morbidity, or at least increases the risk of pulmonary thromboembolism amongst the OR personnel.


Re: Severe attack of upper back pain - Ärzteforum

Post#5 »

I'd stay at home, but my partner is an excellent surgeon.

I think most gallstones in the 2-3mm size range will pass. I would do the lap chole, do the cholangiogram. If there were indeed a 3 mm stone there, I would try to pull or push it out with a fogerty, but if I couldn't get the stone out, I would not do an open CBDE. If the surgeon you choose can't get it out with a fogerty, I'd want him to leave it. I'd let it sit, believing it would pass. When my stools turn white, I'd go get an ERCP.

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Re: Severe attack of upper back pain - Ärzteforum

Post#6 »

I have done lap choles on 3 of my close colleagues, in fact schoolmates since medical school days (although none of them had CBD stones). They did not have any second thoughts (at least none that I know of) about the procedure. They were all happy with the results. If I had your problem, after the repeat ultrasound, I would prefer to undergo ERCP with extraction of the stones prior to a lap chole to be done by somebody I know personally and whom I think does best. That way, I know that my surgeon will only have to do a lap chole at surgery. I would also prefer to have it done at the place where I work and in the morning of a holiday, where there are less people in the OR (of course this is after I have made sure that all key consultants are available to look after me in case something unexpected happens).


Re: Severe attack of upper back pain - Ärzteforum

Post#7 »

I know Joe Petelin, MD (don't particularly like him), but would probably chose him for myself if I thought I had a common bile duct stone, because he makes it look easy on his videos. Shawnee Mission Hospital (where he operates) is my favorite of all the hospitals I have worked at (17 total hospitals). Another choice would be Indiana U in Indianapolis-the GI endoscopists there are very good-my favorite of all the GI endoscopists I have worked with. You may have other favorites.

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Treatment guru

Re: Severe attack of upper back pain - Ärzteforum

Post#8 »

From what you have said, I would go somewhere where I trusted the surgeons. Working closely with other surgeons and covering their patients, we see all their warts. I think I also would be uneasy in a similar situation.


Re: Severe attack of upper back pain - Ärzteforum

Post#9 »

This is funny. This morning at 6 am I had a lap cholecystectomy after a similar history. However I developed acute cholecystitis, so didn't have much choice about the operation. I asked one of my colleagues to do the case, and asked that he be assisted by two of my residents. Not another senior surgeon. I made sure I will get a PCA pump, and as you can see, I am now 8 hours out, and I can sit in my office now, (the office in in the Ward) and read e-mail. On US, my CBD was only 3.7 mm and labs were normal (except for 23000 WBC's) so no cholangiogram was done. I selected 6am because the OR was quiet at that time.

I had the first attack 6 months ago, and postponed the operation, because of similar considerations. Particularly that I too felt that.

Even during the current attack, I tried to avoid the inevitable, and delayed the operation from Saturday to Monday morning, when it became obvious that I could delay no longer. I am told the GB was distended with patchy necrosis, so I had the operation not a moment too soon.

I now think it was silly of me to suffer for a couple of days, out of being concited.

Well, my advice is to ask one of your colleagues to do the operation, and do it before you get acute cholecystitis, or pancreatitis. Do not worry about the possibility of a CBD stone, and just get it over with.

Grandpa Phil

Re: Severe attack of upper back pain - Ärzteforum

Post#10 »

A good set of questions to think about - obviously the answer is - it depends. As you say, how comfortable you are with the surgeon should be the deciding factor. In your case, I wouldn't trust U/S to determine if there is something in the CBD - a simple set of liver function tests will tell you if there is evidence of obstruction - if the bilirubin is normal, no further worry and you should just have a lap chole - I wouldn't even bother with a cholangiogram as it may be better NOT to see its results to prevent a vicious cycle from developinng. If bilirubin is elevated, a pre-op ERCP would be the next best alternative if you don't trust your colleagues' CBDE abilities if cholangiogram (which should be done first - if negative, again no problem!)) is positive. Of course, you would also have to trust the abilities of your colleagues who do ERCP. Another consideration is purely political, and relates to how your colleagues and hospital staff feel if you go elsewhere - what does that say about your REAL assessment of their abilities? And don't start the old argument that now that it is YOU, things are different - things should be no different for you than for any of your patients - if this is not true, what does that say about your concern for your patinets' welfare? How could you in good conscience allow your patients to be taken care of there if you refuse to be? Almost certainly your own facility will be able to take care of your problem.

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