Psychosomatic Therapy and Evaluation on a Case of the Postcholecystectomy Syndrome with Intractabe Abdominal Pain

Abstract

A 46-yr-old female farmer was admitted to the department of psychosomatic medicine of Kyushu University Hospital for treatment of right upper quadrant abdominal pain and abnormal dependence on the analgesic injection. Four years ealier, she received cholecystectomy for recurrent biliary type pain, and was treated with endoscopic sphincterotomy (EST) for suspected sphincter of Oddi spasm in the manometric study prior to admission. The patient, however, has remained troubled by the same kind of pain. Examinations on admission revealed no organic lesion in the biliary system and gut. The mechanism of abdominal pain after EST was considered due to motility abnormality of the gut in this case. Her frequent requirement of injections for abdominal pain embarrased the medical staff every day. Several psychological problems of the patient were pointed out : feeling of solitude and emptiness after hard working or nursing children all her life, its unconscious suppression, and compensatory satisfaction in medical service. Main purpose of our therapy was withdrawal from abnormal dependence on analgetic injections, but its process was very hard. Our medical staff tried to maintain the consistent attitude, "confrontation" to her dependence and "sympathy" to her solitude. An art therapy, "Chigirie" accelerated the therapeutic development of her suppressed inner world in chilhood. Five months later, at the time of discharge she was able to control herself in part even when colicky pain was about to threaten her with a panic.