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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18452
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hi I am a pancreatitis suffer. Back in 2011 I underwent

Resolved Question:

Hi I am a chronic pancreatitis suffer. Back in 2011 I underwent a gastrojejunostomy and a further laparotomy and pancreatic nectosectomy in 2012. I suffer regularly from symptoms of epigastric pain. I am being told by my surgeons that I also have features of dilated biliary tree which has shown up on various imaging. My surgeon has on two occasions (one 0f which was under Propofal) on both occasions he was unable to cannulate my ampulla.In clinic today we discussed the option of hepaticojejunostomy in order to prevent further liver damaged as a result of this. My worry is that in my gastrojejunostomy operation note 2011 that that I have rather short small bowel mexentery and that a formal hepaticojejunostomy may not be technically feasible and that they will not now for sure until they go in. If they can not do this procedure is there any others that may do, As my life at the moment is not good nothing but pain sickness and spending hours on the loo for one or the other. I would welcome your thoughts on the matter should I go with the operation even though there are no guarantee.
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Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some additional information:
Have they said that the liver enzymes are elevated because of this obstruction?

Customer: replied 3 years ago.

yes they have.

Customer: replied 3 years ago.

yes they have

Customer: replied 3 years ago.

yes they have said that.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

I ask this question because it is frequently difficult to say how much of someone's symptoms may be coming from the dilated bile ducts when it is already known that there is a disease process that can cause the same symptoms (chronic pancreatitis in your case). If the liver enzymes are elevated because of the dilated bile ducts, rather than simply being dilated on imaging studies, then that would be a greater indication that it is contributing to your symptoms.

As for the surgery, if you are now discussing this option with the same surgeon that performed the prior surgery, then there is a better chance that the surgeon will be able to successfully perform the surgery. Yes it cannot be definitely known until they are in surgery, but a surgeon that has already performed surgery on you is more likely to accurately predict whether the surgery would be successful.

There is another option to consider that may be able to avoid or postpone surgery. It may be possible to place a drainage tube or a stent through the skin into the dilated bile duct. This is usually done using guidance from imaging. A drainage tube would involve placement of a needle and then a catheter into the dilated bile duct and allow it to drain through the skin. A stent placement would be a similar procedure, but then attempting to pass a wire through the area of obstruction and then place the stent to hold the bile duct open. (People are now used to hearing about stents in the discussion of treatment of narrowings of heart arteries, but a stent can be used in many different anatomic locations.)

Therefore, if today's discussion is with a surgeon that performed the prior surgery and that surgeon is optimistic that surgery would be successful, I would tend to think to proceed with surgery. But if it is more desireable for you to avoid surgery or if surgery cannot be done, then drainage or a stent placement may be an option.

If you need any clarification, please let me know.

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