Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography

Abstract

Post-cholecystectomy syndrome (PCS) is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. Nevertheless, this term is inaccurate, as it encompasses biliary and non-biliary disorders, possibly unrelated to cholecystectomy. Biliary manifestations of PCS may occur early in the post-operative period, usually because of incomplete surgery (retained calculi in the cystic duct remnant or in the common bile duct) or operative complications, such as bile duct injury and/or bile leakage. A later onset is commonly caused by inflammatory scarring strictures involving the sphincter of Oddi or the common bile duct, recurrent calculi or biliary dyskinesia. The traditional imaging approach for PCS has involved ultrasound and/or CT followed by direct cholangiography, whereas manometry of the sphincter of Oddi and biliary scintigraphy have been reserved for cases of biliary dyskinesia. Because of its capability to provide non-invasive high-quality visualisation of the biliary tract, magnetic resonance cholangiopancreatography (MRCP) has been advocated as a reliable imaging tool for assessing patients with suspected PCS and for guiding management decisions. This paper illustrates the rationale for using MRCP, together with the main MRCP biliary findings and diagnostic pitfalls.

Multidetector computed tomography evaluation of post cholecystectomy complications: A tertiary care center experience

“…Biliary leak should be suspected when a collection persists for more than 1 week or occurs outside the gallbladder bed. 18 Kirks et al evaluated the role of CT cholangiography in the detection and localisation of suspected bile leaks. Over a period of 9 years, the authors evaluated 20 patients with suspected bile leaks.…”

Gallrásarsteinar eftir gallblöðrutöku á Landspítala 2008-2011

“…5 Flestar rannsóknir benda til þess að steinar í gallrás sem greinast á fyrstu tveimur árum eftir gallblöðrutöku hafi verið til staðar við aðgerð-ina sjálfa en að þeir sem greinast síðar hafi myndast í gallrás eftir aðgerð. 5,10 Aðrar rannsóknir benda til þess að þetta tímabil sé styttra, eða um 6 mánuðir. 4 Þeir steinar sem myndast í gallrás eru oftast tengdir rennslishindrun og/eða sýkingu í gallrás (cholangitis) og eru 4-10% af öllum steinum í gallrás.…”

“…Miðað við algeng við-mið má álíta að þeir steinar hafi verið til staðar við aðgerð og að hugsanlega hefði mátt finna þá með frekari uppvinnslu. 5,10 Hjá 11 sjúklingum komu gallrásarsteinar fram eftir tvö ár og má þá aetla að þeir hafi myndast síðar í gallrás og því ómögulegt að sjá þá fyrir eða bregðast við þeim þegar aðgerð var framkvaemd.…”

Evaluation of gastroesophageal reflux after laparoscopic cholecystectomy using combined impedance-pH monitoring

“…1 Post-cholecystectomy syndrome (PCS) is one of the complications of cholecystectomy and is defined as a complex of heterogeneous symptoms, consisting of dyspepsia, flatulence, bloating, bitter taste, heartburn and epigastric/ right upper quadrant pain, which recur and/or persist after cholecystectomy. 2 The postulated etiologies for this syndrome includes gastroesophageal reflux, retained common bile duct stones, inflammation of the cystic duct remnant, and sphincter of Oddi dysfunction. 3 Studies examining the effect of cholecystectomy on GER…”