Postcholecystectomy syndrome

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

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

Symptoms of postcholecystectomy syndrome may include:[1]

Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,[4] and can be transient, persistent or lifelong.[5][6] The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.[2]

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

Diagnostics

Treatment

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. Thus, 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.[13]

If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.[8]

References

  1. ↑ nhs.uk, Complications of a gallbladder removal
  2. 1 2 Surcigal Science, Post Cholecystectomy Diarrhoea—A Systematic Review, 2012
  3. ↑ 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.
  4. ↑ "Postcholecystectomy syndrome". WebMD. Retrieved 2009-03-07.
  5. 1 2 Danley T, St Anna L (October 2011). "Clinical inquiry. Postcholecystectomy diarrhea: what relieves it?". The Journal of Family Practice 60 (10): 632c–d. PMID 21977493.
  6. 1 2 Sciarretta G, Furno A, Mazzoni M, Malaguti P (December 1992). "Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test". The American Journal of Gastroenterology 87 (12): 1852–4. PMID 1449156.
  7. ↑ 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.
  8. 1 2 Okoro N, Patel A, Goldstein M, Narahari N, Cai Q (July 2008). "Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis". Gastrointestinal Endoscopy 68 (1): 69–74. doi:10.1016/j.gie.2007.09.046. PMID 18577477.
  9. ↑ Farahmandfar, Mohammad Reza (2012). "Post Cholecystectomy Diarrhoea—A Systematic Review". Surgical Science 3 (6): 332–8. doi:10.4236/ss.2012.36065.
  10. ↑ Odunsi-Shiyanbade ST, Camilleri M, McKinzie S, et al. (February 2010). "Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function". Clinical Gastroenterology and Hepatology 8 (2): 159–65. doi:10.1016/j.cgh.2009.10.020. PMC 2822105. PMID 19879973.
  11. ↑ Zema MJ (2012). "Colesevelam hydrochloride: evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action". Core Evidence 7: 61–75. doi:10.2147/CE.S26725. PMC 3426253. PMID 22936894.
  12. ↑ Puleston J, Morgan H, Andreyev J (March 2005). "New treatment for bile salt malabsorption". Gut 54 (3): 441–2. doi:10.1136/gut.2004.054486. PMC 1774391. PMID 15711000.
  13. ↑ http://medusanews.com/diseases-and-conditions/gastroenterology/postcholecystectomy-syndrome.html[]
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