Post-cholecystectomy syndrome is defined as the recurrence of symptoms similar to those experienced before the cholecystectomy. This usually takes the form of upper abdominal pain (mainly right upper quadrant) and dyspepsia, with or without jaundice. It is defined as early if occurring in the post-operative period and late if it manifests after months or years1,2.
The incidence of postcholecystectomy syndrome has been reported to be between 5% and 40% in one study, and the onset of symptoms may range from 2 days to 25 years3. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% among male patients4.
The most common cause of postcholecystectomy syndrome is an overlooked extrabiliary disorder such as reflux oesophagitis, peptic ulceration, irritable bowel syndrome or chronic pancreatitis5.
Severe symptoms are more likely to represent …show more content…
There have been reports of a cystic duct remnant causing symptoms even after the duct calculi had been removed7-9.
Sphincter of Oddi dysfunction has been implicated in the aetiology of PCS. Such dysfunction can result from a true stenosis or secondary to spasm of the sphincter. In the majority of cases, the dysfunction continues to present problems both in terms of diagnosis as well as treatment. Although muscle spasm is thought to play a significant role in these cases, the response to smooth muscle relaxants such as nitrates and calcium channel antagonists has been disappointing10.
It should be remembered that cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal. The cholecystosphincter of Oddi reflex11, cholecysto-antral reflex12,
The incidence of postcholecystectomy syndrome has been reported to be between 5% and 40% in one study, and the onset of symptoms may range from 2 days to 25 years3. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% among male patients4.
The most common cause of postcholecystectomy syndrome is an overlooked extrabiliary disorder such as reflux oesophagitis, peptic ulceration, irritable bowel syndrome or chronic pancreatitis5.
Severe symptoms are more likely to represent …show more content…
There have been reports of a cystic duct remnant causing symptoms even after the duct calculi had been removed7-9.
Sphincter of Oddi dysfunction has been implicated in the aetiology of PCS. Such dysfunction can result from a true stenosis or secondary to spasm of the sphincter. In the majority of cases, the dysfunction continues to present problems both in terms of diagnosis as well as treatment. Although muscle spasm is thought to play a significant role in these cases, the response to smooth muscle relaxants such as nitrates and calcium channel antagonists has been disappointing10.
It should be remembered that cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal. The cholecystosphincter of Oddi reflex11, cholecysto-antral reflex12,