Advise please, sorry for long post. Complicated case

Complicated case.

2007 gall bladder removed, cut common bile duct during open surgery. Choledochojejunostomy to repair bile duct.

2007 removal of carcinoid cancer from small bowel (same time as above)

2008 bile duct repair failed. First bout of cholangitis (confirmed and treated in hospital) Surgery followed a few days later to repair the stricture of the CBD repair.

2012 more removal of carcinoid cancer from area of initial surgery.

2013 prostate cancer diagnosis. Prostatectomy 6/2013

2013/07 Sepsis from what they said was from prostate surgery. Almost died. Presented to ER in septic shock. Hospitalized for a week. IV Anti for 14 days.

2013 several additional episodes either resolved by themselves, or oral Anti.

2013/02 begin of frequent episodes. 8 this year. Currently having one. WBC 12.5. All liver elevated, Alk Phos only 232 however.

Episodes always the same. Aching in legs, lower back, then all over, rigors, chills, normal temp for me, 97.4, so temp at this stage 98.5, then 99.5 Within one hour, then 100.5, then 101.5, high as 103.5, treat, back to normal in 2 days, run over by a bus.

Episodes more frequent. Having one now. On 750 Leviquin. Have to figure this out. docs seem perplexed. liver numbers staying up now for 6 months indicating possible liver issue. Have scans every 6 months for cancer. Always billary dilation and air.

Any direction appreciated. Need Emory Atlanta suggestions of Hepatologists?

I would get at least two more opinions then decide if I should see different Doctors for my care. best to get all copies of your labs, CT scan, MRCP's so you have something to show the new Doctors and they can follow the changes..

Good Luck!

Your case is one for a very experienced gastroenterologist. Primary Sclerosing Cholangitis goes often unditected for up to ten years. A gall bladder operation may sometimes be the first sign. Damage to the extrahepetical bile duct by itself may cause cholangitis., not necessarily the primary sclerosing kind..

If you have advaned PSC the blood liver enzymes are not just elevated, but highly elevated. With medication this condition can be tolerable. The condition of your bile ducts can be seen using a ERCP. Given your history of surgery in the area only a specialist can tell you whether such an ERCP is possible..

Do get copies of your blood tests showing the levels of Aspartate,transaminase, Alanine Transamionase,, Alkaline Phospatase, Albumin, Billirubin and Gamma-Glutamyltransferase, . Discuss the results with a heptologist..