Postcholecystectomy syndrome
| Postcholecystectomy syndrome | |
| ICD-10 | K91.5 |
|---|---|
| ICD-9 | 576.0 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
The term Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after surgery to remove the gallbladder (Cholecystectomy). Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen. [1]
Historical Perspective
In 1960, Freud M, gastroenterologist, surveyed 114 Post cholecystectomy patients and found 93% had pain, jaundice in 24% and 38% had fever.[2]
Classification
There is no recognized classification of post cholecystectomy syndrome.
Pathophysiology
Most often surgeries done laprascopically lead to trauma or remembrance of stone which are background players of cholecystectomy syndrome.These include bile leakage from an overlooked transection of normal or aberrant bile ducts, obstructive jaundice due to inadvertent ligation of the common duct or its postsurgical stricture, instrumentation injuries induced during biliary tract exploration, and the various types of biliary fistulas.[3]
Causes
The causes can be due to bile duct injury, biliary leak, biliary fistula and retained bile duct stones. If untreated it can lead to include recurrent bile duct stones and bile duct strictures.[4]
Differentiating Postcholecystectomy syndrome from Other Diseases
Common differentials of cholecystectomy syndrome are:
- Organic Extrabiliary Diseases: esophagitis, gastritis, pancreatitis, costosondritis.
- Organic Biliary Diseases: Residual stone, strictures, benign or malignant tumors of the Vater papilla and the periampullary, Choledochal cyst,
- Functional Extrabiliary Causes: irritable bowel syndrome (IBS)
- Functional Biliary Causes: Sphincter of Oddi dysfunction (SOD)
Epidemiology and Demographics
Around 15 to 20 % of patients going through cholecystectomy experience PCS symptoms.
Risk Factors
Following are risk factors of PCS:
- Laparoscopic surgery
- Inexperienced surgeon
Screening:
Patients after cholecystectomy may experience symptoms as pain, jaundice and or fever should be evaluated for PCS.
Natural History, Complications, and Prognosis
Natural History:
Complications:
Prognosis:
Diagnosis
Diagnostic Criteria:
Patient presenting with symptoms should be evaluated with Abdominal ultrasound and blood tests for CBC and LFT's.
History and Symptoms:
Patient may present with abdominal pain, jaundice or dyspeptic symptoms.
Physical Examination:
Laboratory Findings:
| Post cholecystectomy pain | |||||||||||||||||||||||||||||||||||||||||||||||
| History & Physical Examination | |||||||||||||||||||||||||||||||||||||||||||||||
| Lab CBC LFT Serum amylase lipase | |||||||||||||||||||||||||||||||||||||||||||||||
| Transabdominal ultrasound TUS | |||||||||||||||||||||||||||||||||||||||||||||||
| Normal TUS & LFT | TUS CBD>10mm &/or abnormal LFT | TUS with stones | Biloma | Abcess | |||||||||||||||||||||||||||||||||||||||||||
| Workup for non-bilary causes | endoscopic US | ERCP | Percutenous drainage | ||||||||||||||||||||||||||||||||||||||||||||
| Workup for non-bilary causes | If stone: removal of stone with sphincterotomy If no stone: manomatery with or without sphincterotomy | ||||||||||||||||||||||||||||||||||||||||||||||
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Womack, NA (1947). "The Persistence of Symptoms following Cholecystectomy". Annals of Surgery. 126: 31–55. Unknown parameter
|coauthors=ignored (help) - ↑ FREUD M, DJALDETTI M, DE VRIES A, LEFFKOWITZ M (1960). "Postcholecystectomy syndrome: a survey of 114 patients after biliary tract surgery". Gastroenterologia. 93: 288–93. PMID 13824916.
- ↑ Ghahremani GG (1997). "Postsurgical biliary tract complications". Gastroenterologist. 5 (1): 46–57. PMID 9074919.
- ↑ Jaunoo SS, Mohandas S, Almond LM (2010). "Postcholecystectomy syndrome (PCS)". Int J Surg. 8 (1): 15–7. doi:10.1016/j.ijsu.2009.10.008. PMID 19857610.