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]

Dyspepsia, nausea, and vomiting.
Flatulence, bloating, and diarrhea.
Persistent pain in the upper right abdomen.^[2]

Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,^[3] and can be transient, persistent or lifelong.^[4]^[5] The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.

The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions.^[6] A recent study^[7] 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).^[5] This can be treated with a bile acid sequestrant like cholestyramine,^[5] colestipol^[4] or colesevelam,^[8] which may be better tolerated.^[9]

Diagnostics

Ultrasound of the abdominal cavity.
General and biochemical blood.
Intravenous cholangiography.
Esophagogastroduodenoscopy for examination of the stomach, duodenum and the area major duodenal papilla.
Retrograde cholangiopancreatography.
Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)
SeHCAT or other test for bile acid diarrhea

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.^[10]

If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.^[7]

A trial of bile acid sequestrant therapy is recommended for bile acid diarrhoea.^[4]^[9]

References

↑ nhs.uk, Complications of a gallbladder removal
↑ Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, van Laarhoven CJ (2013). "Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness". Surg Endosc. 27 (3): 709–18. doi:10.1007/s00464-012-2516-9. PMID 23052498.
↑ "Postcholecystectomy syndrome". WebMD. Retrieved 2009-03-07.
1 2 3 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.
1 2 3 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.
↑ 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.
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.
↑ 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.
1 2 Mottacki N, Simrén M, Bajor A (2016). "Review article: bile acid diarrhoea - pathogenesis, diagnosis and management". Aliment. Pharmacol. Ther. doi:10.1111/apt.13570. PMID 26913381.
↑ http://medusanews.com/diseases-and-conditions/gastroenterology/postcholecystectomical-syndrome.html

Diseases of the digestive system (primarily K20–K93, 530–579)

Upper GI tract

Esophagus	Esophagitis Candidal Eosinophilic Herpetiform Rupture Boerhaave syndrome Mallory-Weiss syndrome UES Zenker's diverticulum LES Barrett's esophagus Esophageal motility disorder Nutcracker esophagus Achalasia Diffuse esophageal spasm Gastroesophageal reflux disease (GERD) Laryngopharyngeal reflux (LPR) Esophageal stricture Megaesophagus

Stomach	Gastritis Atrophic Ménétrier's disease Gastroenteritis Peptic (gastric) ulcer Cushing ulcer Dieulafoy's lesion Dyspepsia Pyloric stenosis Achlorhydria Gastroparesis Gastroptosis Portal hypertensive gastropathy Gastric antral vascular ectasia Gastric dumping syndrome Gastric volvulus

Lower GI tract:
Intestinal/
Enteropathy

Small intestine (Duodenum/Jejunum/Ileum)	Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption: Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption

Large intestine (Appendix/Colon)	Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis/Diverticulosis

Large and/or small	Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular: Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Ileus Intussusception Volvulus Fecal impaction Constipation Diarrhea Infectious Intestinal adhesions

Rectum	Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus

Anal canal	Anal fissure/Anal fistula Anal abscess Anal dysplasia Pruritus ani

GI bleeding/BIS

Accessory

Liver	Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver NASH Vascular Budd-Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's disease Hemochromatosis

Gallbladder	Cholecystitis Gallstones/Cholecystolithiasis Cholesterolosis Rokitansky-Aschoff sinuses Postcholecystectomy syndrome Porcelain gallbladder

Bile duct/ Other biliary tree	Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis/Mirizzi's syndrome Biliary fistula Haemobilia Gallstones/Cholelithiasis Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction

Pancreatic	Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula

Abdominopelvic

Hernia	Diaphragmatic Congenital Hiatus Inguinal Indirect Direct Umbilical Femoral Obturator Spigelian Lumbar Petit's Grynfeltt-Lesshaft Undefined location Incisional Internal hernia Richter's

Peritoneal	Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum

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