History
A wide range of symptoms may be noted in patients with postcholecystectomy syndrome (PCS). Symptoms are sometimes considered to be associated with the gallbladder. Freud found colic in 93% of patients, pain in 76%, jaundice in 24%, and fever in 38%. [12] In the author’s patient population, the incidence of PCS is 14%. Pain is found in 71% of patients, diarrhea or nausea in 36%, and bloating or gas in 14%. The cause of PCS is identifiable in 95% of patients.
Physical Examination
The workup for PCS varies. An extensive study of the patient should be performed in an attempt to identify a specific cause for the symptoms and to exclude serious postcholecystectomy complications. Surgical reexploration should be considered a last resort.
Patient examination starts with a thorough history and a careful physical examination, with close scrutiny of the old record. Particular attention should be paid to the preoperative workup and diagnosis, the surgical findings and pathologic examination, and any postoperative problems. Discrepancies may lead to the diagnosis. Additional workup is directed at the most likely diagnosis while excluding other possible causes.
Tables
Anatomy |
Etiology |
Gallbladder remnant and cystic duct |
Residual or reformed gallbladder Stump cholelithiasis Neuroma |
Liver |
Fatty infiltration of liver Hepatitis Hydrohepatosis Cirrhosis Chronic idiopathic jaundice Gilbert disease Dubin-Johnson syndrome Hepatolithiasis Sclerosing cholangitis Cyst |
Biliary tract |
Cholangitis Adhesions Trauma Cyst Malignancy and cholangiocarcinoma Choledocholithiasis Dilation without obstruction Hypertension or nonspecific dilation Dyskinesia Fistula |
Periampullary |
Sphincter of Oddi dyskinesia, spasm, or hypertrophy Sphincter of Oddi stricture Papilloma Cancer |
Pancreas |
Pancreatic stone Pancreatic cysts Benign tumors |
Esophagus |
Aerophagia Achalasia |
Stomach |
Bile gastritis Peptic ulcer disease Gastric cancer |
Duodenum |
Adhesions |
Small bowel |
Adhesions Incisional hernia |
Colon [5] |
Diarrhea Incisional hernia Irritable bowel disease |
Vascular |
Intestinal angina Coronary angina |
Nerve |
Neuroma Intercostal neuralgia Spinal nerve lesions Sympathetic imbalance Neurosis Psychic tension or anxiety |
Bone |
Arthritis |
Other |
20% organ other than hepatobiliary or pancreatic Foreign bodies, including gallstones and surgical clips |
