Postcholecystectomy syndrome describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy), 2 years after the surgery.
Symptoms of postcholecystectomy syndrome may include:
- Dyspepsia, nausea, and vomiting.
- Flatulence, bloating, and diarrhea.
- Persistent pain in the upper right abdomen.
Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.
The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions. A recent study shows that postcholecystectomy syndrome can be caused by biliary microlithiasis.
Approximately 50% of cases are due to biliary causes such as remaining stone, biliary injury, dysmotility, and choledococyst. The remaining 50% are due to non-biliary causes. This is because upper abdominal pain and gallstones are both common but are not always related.
Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3). This can be treated with a bile acid sequestrant like cholestyramine, colestipol or colesevelam, which may be better tolerated.
Diagnostics
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- Ultrasound of the abdominal cavity.
- General and biochemical blood.
- Intravenous cholangiography.
- Esophagogastroduodenoscopy for examination of the stomach, duodenum and the area major duodenal papilla.
- Retrograde cholangiopancreatography.
- Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)
- SeHCAT or other test for bile acid diarrhea
Treatment
Some individuals may benefit from diet modification, such as a reduced fat diet, following cholecystectomy. The liver produces bile and the gallbladder acts as reservoir. From the gallbladder, bile enters the intestine in individual portions. In the absence of gallbladder, bile enters the intestine constantly, but in small quantities. Thus, it may be insufficient for digestion of fatty foods. Postcholecystectomy syndrome treatment depends on the identified violations that led to it. Typically, the patient is recommended dietary restriction table with fatty foods, enzyme preparations, antispasmodics, sometimes cholagogue.
If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.
A trial of bile acid sequestrant therapy is recommended for bile acid diarrhoea.
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