Female patient in her 50s. Since she turned 18 she's has multiple episodes of cholangitis and colic. cholangiolithiasis (pronounced) and choledocholithiasis. The gallbladder was removed 30 years ago and has had ERCP three times.
I have met her this week and I found it very interesting that she has diarrhea since many years (3x per day, fluid, light-colored). I do not think it is a secondary problem, as the urine eis normal.
She also has no CED.
What did the ERCP/ MRCP show? Any features of PSC or "oriental" cholangitis. What's her LFTs? How did you characterise her diarrhoea - steatorrhoea? Any features of chronic pancreatitis - risk factors or features on imaging including EUS? Any ductal strictures to suggest IgG4 disease - including pancreatic duct involvement? Diarrhoea may or may not be associated with cholangitis but consider also UC if PSC identified. Is CED coeliac disease and you've done the duodenal biopsies? Most common cause of diarrhoea following cholecystectomy would be bile salt irritation and improves on cholestyramine.
In addition to the above (all good considerations), you need a good social history to rule out any life-style factors that may be contributing to it. What is she eating? Does she drink or use recreational drugs? What medicines medicines (prescription and over-the-counter), supplements/herbal medicines does she take?
Hi,
no chronic pancreatitis, no CED. Maybe it is a bile salt problem, but she has no cholestasis. I will do patients history again, but she seems quite intelligent and did exclude any dietary problems last time I saw her...
I thought it may also be a short-bowel problem due to a fistula?
Its seems to be a case of PCS chronic diarrhea or PCD. Oral cholestyramine may normalized bowel movement.
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