Postcholecystectomy syndrome describes abdominal symptoms, two years after cholecystectomy (removal of the gallbladder).
Symptoms occur in about 5 to 40 percent of patients undergoing cholecystectomy, and may be temporary, persistent or lifelong. Chronic conditions are diagnosed in about 10% of postcholecystectomy cases.
The pain associated with postcholecystectomy syndrome is usually considered to be either an Oddi dysfunction sphincter or post-surgical adhesion. A new study suggests that postcholecystectomy syndrome can be caused by biliary microlithiasis. Approximately 50% of cases are caused by bile causes such as remaining stones, biliary injuries, dysmotility, and choledococyst. The remaining 50% is due to non-biliary causes. This is because upper abdominal pain and gallstones are both common but not necessarily related.
Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3). It can be treated with bile acid sequestrants such as cholestyramine, colestipol or colesevelam, which can be better tolerated.
Video Postcholecystectomy syndrome
Presentations
Symptoms of postcholecystectomy syndrome may include:
- Dyspepsia, nausea, and vomiting.
- Flatulence, bloating, and diarrhea.
- Persistent pain in the upper right abdomen.
Maps Postcholecystectomy syndrome
Diagnostics
- Ultrasound in the abdominal cavity.
- Common blood and biochemistry.
- Intravenous cholangiography.
- Esophagogastroduodenoscopy for examination of the stomach, duodenum and the main duodenal papilla area.
- Retrograde cholangiopancreatography.
- Analysis of biliary bile obtained through endoscopic retrograde cholangiopancreatography (ERCP)
- SeCCAT or other tests for bile acid diarrhea
Treatment
Some individuals may benefit from dietary modifications, such as low-fat diets, following cholecystectomy. The liver produces bile and the gallbladder acts as a reservoir. From the gallbladder, bile enters the intestine in an individual portion. In the absence of the gallbladder, bile enters the intestine constantly, but in small amounts. Thus, it may not be enough for the digestion of fatty foods. Postcholecystectomy syndrome therapy depends on the identified offense that causes it. Typically, patients are recommended table restrictions on diet with fatty foods, enzyme preparation, antispasmodik, sometimes cholagogue.
If the pain is caused by bile microlitiasis, oral ursodeoxycholic acid may relieve the condition.
A trial of bile acid sequestrant therapy is recommended for bile acid diarrhea.
References
External links
Source of the article : Wikipedia
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