Aa
upper right pain
I had my gallbladder out 4 years ago. I was told I had a cyst on my liver and on my kidney, not to be concerned. For the past 3 years I get this pain under my right rib cage that feels like someone is taking my organ and twisting it really tight. The pain makes me double over and as I stay still it starts to relax and eventually go away. Also, This past year I have experienced pain again like I still have a Gallbladder. My GI doctor diagnosed Sphincter of Oddi dysfunction and I had the procedure done where they went in and made a cut in the bile duct area to allow better flow. It has been three months and I have the pain back again and still get that really tight pain behind my right rib cage. My blood work last week showed a slightly elevated liver enzymes so not sure if this is all connected. I can't help but feel like my doctor isn't sure and feel like a guinea pig. Any suggestions on what I should do or if I need to see a different GI doctor?
Hello Queen,
Welcome to MedHelp's Pain Management Forum. I am glad that you found us but sorry to hear about your undiagnosed pain. We know how frustrating it can be to search for that elusive DX.
First I want to comment on Fritzi's response to your post. Indeed I found this very interesting and it is a possibility in your case. However due to your elevated Liver Enzymes, Cholecystectomy and the DX of Sphincter of Oddi Dysfunction I think you should have all other possibilities ruled out first. Sometimes there is an elusive stone trapped in one of the ducts or other such issues. I would seek a second opinion to determine what may be happening IF your current PCP or Surgeon is unable to find a solution. I encourage ppl to consult a physician associated with a large teaching hospital as they seem to be on the cutting edge of the latest in medical science.
If all all DXs are ruled out I certainly would consider ACNES. About a year ago I was hospitalized with acute, extreme URQ pain. I was non-functioning due to the extreme pain. My situation is far different from yours as a seat-belt severed me to the spine some years ago. I have/had a huge abd/lumbar (not spine) hernia but our pain sounds similar. I too have cysts on my liver and kidney. All the usual tests were negative ..... and after consulting thee best Surgeons & Internal Medicine Physicians in our state (and long story short) it was determined that I have entrapped nerves. There are no treatment options for me. However I at least know why I have this usually episodic extreme pain and that knowing I have a reason at least comforts me. Medications have made it more tolerable. Mine can be more burning in nature then you report yours to be. However no real name was given to the condition and it may not be exactly ACNES but it certainly sounds identical to what I have been told. So please keep this in mind if all the usual and customary tests return "normal."
In part my pain is also due to adhesions and you may have some component of that in your pain also. Don't be discouraged,... I know how frustrating it is to search for a DX. You are your own best advocate. Be assertive and insist on answers.
I wish you well and hope that you will let us know how you are doing. I hope you will be active in our community. I'll look forward to your updates.
Take Care,
~Tuck
Welcome to MedHelp's Pain Management Forum. I am glad that you found us but sorry to hear about your undiagnosed pain. We know how frustrating it can be to search for that elusive DX.
First I want to comment on Fritzi's response to your post. Indeed I found this very interesting and it is a possibility in your case. However due to your elevated Liver Enzymes, Cholecystectomy and the DX of Sphincter of Oddi Dysfunction I think you should have all other possibilities ruled out first. Sometimes there is an elusive stone trapped in one of the ducts or other such issues. I would seek a second opinion to determine what may be happening IF your current PCP or Surgeon is unable to find a solution. I encourage ppl to consult a physician associated with a large teaching hospital as they seem to be on the cutting edge of the latest in medical science.
If all all DXs are ruled out I certainly would consider ACNES. About a year ago I was hospitalized with acute, extreme URQ pain. I was non-functioning due to the extreme pain. My situation is far different from yours as a seat-belt severed me to the spine some years ago. I have/had a huge abd/lumbar (not spine) hernia but our pain sounds similar. I too have cysts on my liver and kidney. All the usual tests were negative ..... and after consulting thee best Surgeons & Internal Medicine Physicians in our state (and long story short) it was determined that I have entrapped nerves. There are no treatment options for me. However I at least know why I have this usually episodic extreme pain and that knowing I have a reason at least comforts me. Medications have made it more tolerable. Mine can be more burning in nature then you report yours to be. However no real name was given to the condition and it may not be exactly ACNES but it certainly sounds identical to what I have been told. So please keep this in mind if all the usual and customary tests return "normal."
In part my pain is also due to adhesions and you may have some component of that in your pain also. Don't be discouraged,... I know how frustrating it is to search for a DX. You are your own best advocate. Be assertive and insist on answers.
I wish you well and hope that you will let us know how you are doing. I hope you will be active in our community. I'll look forward to your updates.
Take Care,
~Tuck
I am not in the health care field but have been suffering with RUQ pain for almost 3 months, I found this diagnosis that fits but the doctors say they do not do this kind of injection and they are sure it is something else so, off I go to another specialist, it is so frustrating as my overall health is suffering due to loss of appetite, no exercise etc, anyway, maybe this post will help someone else as it seems to fit a lot of your symptoms:
Abdominal cutaneous nerve entrapment syndrome (ACNES) may sound like an esoteric condition rarely seen by clinicians but is a common condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses.
Beginning in 1792 with J P Frank's description of the condition he named "peritonitis muscularis,"1 a sampling of pertinent medical literature on this subject2-9 shows how often the subject has been written about over the years. These articles state that abdominal wall pain is often wrongly attributed to intra-abdominal disorders and that this misdirected diagnosis can lead to unnecessary consultation, testing, and even abdominal surgery, all of which can be avoided if the initial examiner makes the right diagnosis. In a study of 117 patients in 1999, Greenbaum10 estimated that the amount of money expended on unnecessary workup was $914 per patient. In 2001, Thompson et al11 noted that an average of $6727 per patient was required for previous diagnostic testing and hospital charges. Hershfield6 listed preliminary diagnoses of patients referred to him as irritable bowel, spastic colon, gastritis, psychoneurosis, depression, anxiety, hysteria, and malingering. Many of these patients were given a psychiatric diagnosis when the actual diagnosis could not be determined. In fact, the most common cause of abdominal wall pain is nerve entrapment at the lateral border of the rectus abdominis muscle;3,5,8,9,12 Carnett,3 in the early 20th century, called this syndrome "intercostal neuralgia" and claimed to have seen three patients per week with this diagnosis and as many as three per day in consultation sessions.
Acute cases of ACNES are usually seen in the evening, especially in spring and summer, when people are more active. Chronic and recurrent cases are more likely to be seen in the daytime throughout the year.
To avoid causing the patient unnecessary anxiety and tension, loss of work time, and both the expense and possible hazard of multiple diagnostic procedures, the first physician examining the patient must establish the diagnosis of ACNES if this condition is present. Compiled from my own experience and that of other investigators who have written about ACNES, the information presented here should give readers the tools necessary for diagnosing and treating this condition.
Abdominal cutaneous nerve entrapment syndrome (ACNES) may sound like an esoteric condition rarely seen by clinicians but is a common condition. When a patient is seen for abdominal pain without other clinically significant symptoms, ACNES should be high on the list of likely diagnoses.
Beginning in 1792 with J P Frank's description of the condition he named "peritonitis muscularis,"1 a sampling of pertinent medical literature on this subject2-9 shows how often the subject has been written about over the years. These articles state that abdominal wall pain is often wrongly attributed to intra-abdominal disorders and that this misdirected diagnosis can lead to unnecessary consultation, testing, and even abdominal surgery, all of which can be avoided if the initial examiner makes the right diagnosis. In a study of 117 patients in 1999, Greenbaum10 estimated that the amount of money expended on unnecessary workup was $914 per patient. In 2001, Thompson et al11 noted that an average of $6727 per patient was required for previous diagnostic testing and hospital charges. Hershfield6 listed preliminary diagnoses of patients referred to him as irritable bowel, spastic colon, gastritis, psychoneurosis, depression, anxiety, hysteria, and malingering. Many of these patients were given a psychiatric diagnosis when the actual diagnosis could not be determined. In fact, the most common cause of abdominal wall pain is nerve entrapment at the lateral border of the rectus abdominis muscle;3,5,8,9,12 Carnett,3 in the early 20th century, called this syndrome "intercostal neuralgia" and claimed to have seen three patients per week with this diagnosis and as many as three per day in consultation sessions.
Acute cases of ACNES are usually seen in the evening, especially in spring and summer, when people are more active. Chronic and recurrent cases are more likely to be seen in the daytime throughout the year.
To avoid causing the patient unnecessary anxiety and tension, loss of work time, and both the expense and possible hazard of multiple diagnostic procedures, the first physician examining the patient must establish the diagnosis of ACNES if this condition is present. Compiled from my own experience and that of other investigators who have written about ACNES, the information presented here should give readers the tools necessary for diagnosing and treating this condition.
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