Fall, 2015

Patient’s symptoms improved overnight. He had stable vital signs, soft and completely non-tender abdomen, lack of fever, normal white blood cell count and no evidence of jaundice.  Final assessment was resolving acute cholecystitis of gallbladder remnant with a second cholecystectomy, if necessary, performed as an elective procedure.  Patient was cleared to resume normal diet and activity.

“Post-cholecystectomy syndrome (PCS) consists of a group of abdominal symptoms that recur and and/or persist after cholecystectomy (Girometti, et al., 2010)” both biliary and extra-biliary in origin.  Early PCS is characterized as within the immediate post-operative period, while late PCS is characterized as having onset months to years following cholecystectomy.   This patient would be categorized as late PCS with onset was five years post-cholecystectomy.  Transabdominal sonography is the preferred imaging modality for the initial evaluation of PCS.  Further studies may include a CT followed by direct cholangiography and/or magnetic resonance cholangiopancreatography (MRCP) to further assess the biliary tract (Girometti, et al., 2010).  An endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangio-pancreatography (ERCP) are possible studies for patients with elevated liver function tests and/or common bile duct stones and/or dilated common bile duct (> 10 mm identified by sonography).  Although results of EUS and ERCP are quite accurate, these exams are invasive procedures with significant risk of complications (Terhaar, Jan 2005).  

Symptoms of PCS may include abdominal pain, colic, nausea and vomiting, jaundice, with or without fever (Jensen, 2014). It is important to note that complications from surgery may be mistaken for severe symptoms of early PCS. Treatment for PCS is based on underlying cause determined by previously discussed testing and may range from medication to surgery.

Works Cited

Girometti, R., Brondani, G., Cereser, L., Como, G., Del Pin, M., Bazzocchi, M., et al. (2010). Post- cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. The British Journal of Radiology , 83(988), 351-361.

Terhaar, O. e. (Jan 2005). Imaging patients with "post-cholecystectomy syndrome": an algorithmic approach. Clinical Radiology , 60 (1), 78-84. DOI: http://dx.doi.org/10.1016/j.crad.2004.02.014

Jenson, S. (2014, October 31). Postcholecystectomy Syndrome. Retrieved October 7, 2015, from http://emedicine.medscape.com/article/192761-overview