Post-Surgery Abdominal Pain After Bile Duct Stone Removal

Laparotomy for the removal of bile duct stones?

Hello doctor, I have a history of liver transplantation.
On October 3rd, I experienced upper abdominal pain and went to the emergency room at National Taiwan University Hospital on the early morning of October 4th, where I was admitted.
I was diagnosed with bile duct stones and had a drainage tube inserted to drain bile.
On October 31st, I underwent traditional open surgery to connect the bile duct to the jejunum.
I was discharged on November 11th without having my stitches removed.
The incision still hurts when I move around.

Yesterday, on November 16th, I suddenly experienced upper abdominal pain at around 5 AM for about five minutes.
This morning at 6:30 AM, I had upper abdominal pain again that lasted for about half an hour, and I still feel a sense of discomfort now.
I would like to know the possible reasons for this.
Could it be due to eating too much oily food, or is there another cause? Since I had the drainage tube inserted on October 4th until my discharge after the surgery, I did not experience any pain.
On the evening of the 15th, I had rice noodle soup with some large intestine and fried tofu.
However, on the early morning of the 16th, I suddenly felt pain, and after starting to drink homemade chicken essence from my mother, which had the oil skimmed off, I experienced more prolonged pain at 6:30 AM today.
What could be the cause of this?

Wenwen, 40~49 year old female. Ask Date: 2022/11/17

Dr. Hu Guozheng reply Gastroenterology and Hepatology

Hello, there are many causes of upper abdominal pain.
If it occurs after meals and is related to fatty foods, it is indeed important to be cautious about pain originating from the gallbladder or pancreas.
However, pain from other gastrointestinal sources is also possible.
Given that you have undergone liver transplant surgery and have a history of bile duct stones, it is essential to evaluate the reasons for the liver transplant and the circumstances during the surgery as well.
If your symptoms persist or recur, I strongly recommend that you return to the hospital for an examination.

Reply Date: 2022/11/17

More Info

Post-surgery abdominal pain, especially after a procedure like bile duct stone removal, can be concerning and may arise from various factors. Given your medical history, including a liver transplant and recent surgery, it is essential to consider both surgical and dietary influences on your current symptoms.

Firstly, it is not uncommon to experience some degree of abdominal pain after surgery. The surgical procedure itself can lead to inflammation, irritation of the abdominal wall, or even nerve damage, which may manifest as pain. The fact that you had a traditional open surgery to remove bile duct stones and connect the bile duct to the intestine (jejunum) means that there was significant manipulation of the abdominal organs, which can lead to postoperative discomfort. This discomfort can persist for weeks or even months as the body heals.

Your recent episodes of abdominal pain, particularly after consuming certain foods, may indicate that your digestive system is still adjusting post-surgery. After a bile duct procedure, your body may have altered bile flow, which can affect digestion, especially of fatty foods. The pain you experienced after eating fried tofu and large intestine could be due to the high-fat content of these foods, which may be harder for your digestive system to process at this stage. It is generally recommended to follow a low-fat, easily digestible diet after such surgeries to minimize discomfort and promote healing.

Additionally, the pain you felt after consuming chicken essence (even with the fat removed) could also be a contributing factor. While chicken essence is often considered nutritious, it can still be rich in protein and may cause discomfort if your digestive system is still sensitive. It’s crucial to listen to your body and adjust your diet accordingly. Gradually reintroducing foods and monitoring your symptoms can help identify any specific triggers.

Regarding your surgical site, it is normal to experience some pain and discomfort as the incision heals. However, if the pain is severe, persistent, or accompanied by other symptoms such as fever, jaundice, or changes in bowel habits, it is essential to seek medical attention. These could be signs of complications such as infection, bile leakage, or obstruction.

In conclusion, your abdominal pain could be attributed to a combination of postoperative healing, dietary choices, and possibly the adjustment of your digestive system after surgery. It is advisable to maintain a low-fat diet, avoid overly rich or heavy foods, and consult your healthcare provider regarding your symptoms. They may recommend imaging studies or further evaluations to rule out any complications related to your surgery. Always prioritize communication with your healthcare team, especially given your complex medical history.

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