Postcholecystectomy syndrome

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Postcholecystectomy syndrome
Classification and external resources
ICD-10 K91.5
ICD-9 576.0

Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after surgical removal of the gallbladder (Cholecystectomy).

Symptoms of postcholecystectomy syndrome may include:

  • Upset stomach, nausea, and vomiting.
  • Gas, bloating, and diarrhea.
  • Persistent pain in the upper right abdomen.[1]

Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,[2] and can be transient, persistent or lifelong.[3][4]

The pain associated with post-cholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions.[5] A recent study[6] shows that post-cholecystectomy 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).[7] This can be treated with a bile acid sequestrant like cholestyramine[8][9][10] or colesevelam,[11][12] which may be better tolerated.[13]

Diagnostics[edit]

  • 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)

Shishiveni Treatment[edit]

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. That’s why 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.[14]

If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.[6]

References[edit]

  1. ^ Womack NA, Crider RL (1947). "The Persistence of Symptoms Following Cholecystectomy". Ann. Surg. 126 (1): 31–55. doi:10.1097/00000658-194707000-00004. PMC 1803303. PMID 17858976. 
  2. ^ "Postcholecystectomy syndrome". WebMD. Retrieved 2009-03-07. 
  3. ^ Postcholecystectomy diarrhea: What relieves it?
  4. ^ Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test
  5. ^ Hyvärinen H, Sipponen P, Silvennoinen E (December 1990). "Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome". Hepatogastroenterology 37 (Suppl 2): 58–61. PMID 2083937. 
  6. ^ a b http://www.ncbi.nlm.nih.gov/pubmed/18577477
  7. ^ Sciarretta, G; Furno, A; Mazzoni, M; Malaguti, P (Dec 1992). "Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test.". The American journal of gastroenterology 87 (12): 1852–4. PMID 1449156. 
  8. ^ http://www.scirp.org/Journal/PaperDownload.aspx?paperID=19988
  9. ^ http://www.ncbi.nlm.nih.gov/pubmed/1449156
  10. ^ http://www.jfponline.com/pages.asp?aid=9932
  11. ^ US National Library of Medicine, Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function
  12. ^ US National Library of Medicine, Colesevelam hydrochloride: evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action
  13. ^ US National Library of Medicine, New treatment for bile salt malabsorption
  14. ^ http://medusanews.com/diseases-and-conditions/gastroenterology/postcholecystectomy-syndrome.html