Colelitiasis en Remanente vesicular: reporte de caso / Cholelithiasis in gallbladder remnant: case report / Colelitíase em remanescente de vesícula biliar: relato de caso

Los cálculos biliares se encuentran dentro de los motivos de consulta más frecuentes a nivel mundial, la entidad quirúrgica emergente es la colecistitis en el 90-95 % de los casos, la colecistectomía laparoscópica es la opción ideal de tratamiento, la persistencia de sintomatología postoperatoria, inclusive en el transcurrir de los años es frecuente, en este contexto, es preciso mencionar al síndrome post-colecistectomía que es poco reportado en la localidad. Se presenta el caso de paciente masculino de 71 años de edad con antecedente de colecistectomía abierta hace 13 años, que consulta por meteorismo abdominal, dispepsia, leve dolor en hipocondrio derecho. En los exámenes complementarios de imagen, por ecografía de abdomen, se evidencia colelitiasis en muñón vesicular remanente, diagnóstico certificado por resonancia magnética, indicada previamente por facultativo para control de sus comorbilidades, en el cual se da el hallazgo incidental de litiasis vesicular. Se realiza manejo quirúrgico, colecistectomía laparoscópica, sin ninguna complicación. El paciente mostró adecuada evolución postquirúrgica, siendo dado de alta con analgesia y antibioticoterapia.

Gallstones are among the most frequent reasons for consultation worldwide, the emerging surgical entity is cholecystitis in 90-95% of cases, laparoscopic cholecystectomy is the ideal treatment option, the persistence of postoperative symptoms, even in the passing of the years it is frequent, in this context, it is necessary to mention the post-cholecystectomy syndrome that is little reported in the locality. We present the case of a 71-year-old male patient with a history of open cholecystectomy 13 years ago, who consulted for abdominal bloating, dyspepsia, and mild pain in the right hypochondrium. In the complementary imaging tests, by abdominal ultrasound, cholelithiasis is evidenced in the remaining gallbladder stump, a diagnosis certified by magnetic resonance, previously indicated by the physician to control his comorbidities, in which the incidental finding of gallbladder lithiasis occurs. Surgical management is performed, laparoscopic cholecystectomy, without any complications. The patient showed adequate postoperative evolution, being discharged with analgesia and antibiotic therapy.

Os cálculos biliares estão entre os motivos de consulta mais frequentes em todo o mundo, a entidade cirúrgica emergente é a colecistite em 90-95% dos casos, a colecistectomia laparoscópica é a opção de tratamento ideal, a persistência dos sintomas pós-operatórios, mesmo com o passar dos anos é frequente, nesse contexto, é necessário citar a síndrome pós-colecistectomia que é pouco relatada na localidade. Apresentamos o caso de um paciente do sexo masculino de 71 anos com história de colecistectomia aberta há 13 anos, que consultou por dispepsia, dispepsia e dor leve no hipocôndrio direito. Nos exames complementares de imagem, por ultrassonografia abdominal, evidencia-se colelitíase no coto vesicular remanescente, diagnóstico certificado por ressonância magnética, previamente indicado pelo médico para controle de suas comorbidades, em que ocorre o achado incidental de litíase vesicular. O manejo cirúrgico é realizado, colecistectomia laparoscópica, sem complicações. A paciente apresentou evolução pós-operatória adequada, recebendo alta com analgesia e antibioticoterapia.

Association between dietary intake and postlaparoscopic cholecystectomic symptoms in patients with gallbladder disease

BACKGROUND/AIMS: After cholecystectomy, patients have reported postcholecystectomic syndromes such as abdominal symptoms, dyspepsia, and diarrhea, which suggest a relationship between cholecystectomic symptoms and diet, although the details of this association remain unclear. The present study investigated the hypothesis that dietary intake of nutrients and foods was significantly associated with postcholecystectomic syndromes. METHODS: Gallstone patients (n = 59) who underwent laparoscopic cholecystectomy were enrolled, and dietary intake and clinical parameters were assessed immediately postcholecystectomy and 3 months later. RESULTS: There were no significant differences in biochemical measurements or characteristics between symptomatic and asymptomatic patients. Immediately postcholecystectomy, there were no significant differences in consumption of nutrients or foods between symptomatic and asymptomatic patients. However, 3 months after cholecystectomy, symptomatic patients consumed more animal protein, cholesterol, and eggs, and fewer vegetables than did asymptomatic patients. Multivariable-adjusted regression analyses also indicated that the risk for symptoms was positively associated with intake of animal protein, cholesterol, and eggs, but negatively associated with intake of vegetables after adjusting for confounders. In addition, symptomatic patients consumed more bread-based breakfast foods, while asymptomatic patients consumed more rice. CONCLUSIONS: Postcholecystectomic syndromes were positively associated with intake of cholesterol, animal protein, and eggs, and negatively associated with intake of vegetables, suggesting that diet was plays a role in postcholecystectomic syndromes.

Diagnosis, treatment, and prevention of postcholecystectomy syndrome / 临床肝胆病杂志

Postcholecystectomy syndrome (PCS) is a common syndrome with complex etiologies after laparoscopic cholecystectomy, rather than a specific disease. In addition to bile duct stones, bile duct injury, and sphincter of Oddi dysfunction, PCS is also associated with the abnormalities in bile acid pool, farnesoid X receptor, and GPBAR1/TGR5 pathways after surgery, reductions in fibroblast growth factor 19 and surfactant protein D, changes in gastrointestinal hormones such as motilin and cholecystokinin, and disappearance of various physiological reflexes and nerve reflexes involving the gallbladder. All these changes in physiological function can induce PCS. As the number of patients undergoing laparoscopic cholecystectomy is increasing year by year, the incidence rate of PCS is also increasing. This article briefly summarizes the etiology, pathophysiology, diagnosis, treatment, and prevention of PCS.

Postcholecystectomy syndrome: symptom clusters after laparoscopic cholecystectomy

PURPOSE: Postcholecystectomy syndrome (PCS) is characterized by abdominal symptoms following gallbladder removal. However, there is no consensus for the definition or treatment for PCS. The purpose of this study was to define PCS among various symptoms after laparoscopic cholecystectomy, and to identify risk factors affecting PCS. METHODS: This study was conducted at Dongguk University Ilsan Hospital and Chung-Ang University Hospital (2012–2013). Outcomes were assessed using European Organization for Research and Treatment of Cancer QLQ–C30 questionnaire. Symptom cluster for determining PCS was made by factor analysis. Cluster analysis evaluating risk factors of PCS was made by Ward methods and Dentogram. RESULTS: Factor analysis revealed three distinct symptom clusters, those are ‘insomnia and financial difficulties (eigenvalue, 1.707; Cronbach α, 0.190),’‘appetite loss and constipation (eigenvalue, 1.413; Cronbach α, 0.480),’ and ‘right upper quadrant (RUQ) pain and diarrhea (eigenvalue, 1.245; Cronbach α, 0.315).’ Among these symptom clusters, the cluster of ‘RUQ pain and diarrhea’ was determined as PCS. However, we could not find any risk factors between high symptomatic group and low symptomatic group. CONCLUSION: PCS could consist of RUQ pain and diarrhea. Well-designed prospective trials are needed to determine risk factors of PCS.

Diarrea poscolecistectomía: ¿un problema frecuente? / Postcholecystectomy diarrhea is a frequent problem?

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía¼ la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada¼ como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.

Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.

Research advances in sump syndrome / 临床肝胆病杂志

Sump syndrome is a rare complication of side-to-side choledochoduodenostomy (CDD) and occasionally occurs after spontaneous gallbladder-bile duct-digestive tract fistula or end-to-side choledochojejunostomy.Before the development of minimally invasive surgery,conventional surgical operation used to be the most important treatment method.This article reviews the research advances in sump syndrome in recent years and points out that endoscopic retrograde cholangiopancreatography is the major diagnostic method for this disease,and endoscopic sphincterotomy combined with bile duct debridement is the most simple and effective measure for the treatment of sump syndrome.Meanwhile,this article briefly reviews sump syndrome with reference to related literature and clinical practice,in order to raise the awareness for sump syndrome.

The investigation and risk factors analysis of postcholecystectomy syndrome / 天津医药

Objective To investigate the incidence and risk factors of postcholecystectomy syndrome (PCS), and provide theoretical basis for the prevention of PCS. Methods A total of 338 patients with PCS were randomly selected in our hospital from May 1st 2013 to April 30th 2014, in which 316 cases were successful followed up including 101 males and 215 females. The data were collected from the 7 aspects including blood type, drinking history, smoking history, diabetes history, mental anxiety, dietary tendence and preoperative symptoms, and which were analyzed by binary-logistic regression analysis. Results According to the PCS diagnostic criteria, 115 patients were diagnosed with PCS (36.39%). The anxiety status and preoperative discomfort were closely related to the occurrence of PCS, with statistically significant difference (P<0.05). Conclusion The diagnosis and treatment of PCS are more complicated. We should focus on the prevention of PCS according to its risk factors, and pay attention to preoperative communication and individualized analysis of patients in order to reduce the occurrence of PCS.

Research progress in postcholecystectomy syndrome / 临床肝胆病杂志

Post-cholecystectomy syndrome (PCS) is a common digestive disease. The incidence of PCS is increasing with the popularization of laparoscopic technique. This article introduces the etiology, diagnosis, and treatment of PCS, and discusses the controversy over whether the gallbladder should be resected, so as to improve the treatment outcome of PCS.

Research progress in postcholecystectomy syndrome / 临床肝胆病杂志

Post-cholecystectomy syndrome (PCS) is a common digestive disease. The incidence of PCS is increasing with the popularization of laparoscopic technique. This article introduces the etiology, diagnosis, and treatment of PCS, and discusses the controversy over whether the gallbladder should be resected, so as to improve the treatment outcome of PCS.

Síndrome poscolecistectomía: problema frecuente, poco tratado / Postcholecystectomy syndrome: a common but scarcely studied condition

Se comentan los principales aspectos clínicos del síndrome poscolecistectomía, las dificultades para su comprensión y atención, así como la escasa alusión a este cuadro en los programas convencionales de pregrado y posgrado médicos. Se hace énfasis en el creciente número de pacientes que son sometidos a intervenciones de vesícula biliar realizadas por mínimo acceso a través de la videolaparoscopia, donde hay un porcentaje potencial de enfermos que desarrollan este síndrome y que acuden a los servicios de salud...

Comments are provided on the main clinical aspects of the postcholecystectomy syndrome, the difficulties involved in its comprehension and treatment, and the scant reference to this condition in conventional undergraduate and graduate syllabuses. Emphasis is made on the growing number of patients undergoing minimal access videolaparoscopic cholecystectomy, a potential proportion of whom will develop the syndrome and request medical care...

Fate of Dyspeptic or Colonic Symptoms After Laparoscopic Cholecystectomy

BACKGROUND/AIMS: Gallbladder diseases can give rise to dyspeptic or colonic symptoms in addition to biliary pain. Although most biliary pain shows improvement after cholecystectomy, the fates of dyspeptic or colonic symptoms still remain controversial. This study assessed whether nonspecific gastrointestinal symptoms improved after laparoscopic cholecystectomy (LC) and identified the characteristics of patients who experienced continuing or exacerbated symptoms following surgery. METHODS: Sixty-five patients who underwent LC for uncomplicated gallbladder stones or gallbladder polyps were enrolled. The patients were surveyed on their dyspeptic or colonic symptoms before surgery and again at 3 and 6 months after surgery. Patients' mental sanity was also assessed using a psychological symptom score with the Symptom Checklist-90-Revised questionnaire. RESULTS: Forty-four (67.7%) patients showed one or more dyspeptic or colonic symptoms before surgery. Among these, 31 (47.7%) and 36 (55.4%) patients showed improvement at 3 and 6 months after surgery, respectively. However, 18.5% of patients showed continuing or exacerbated symptoms at 6 months after surgery. These patients did not differ with respect to gallstone or gallbladder polyps, but differed in frequency of gastritis. These patients reported lower postoperative satisfaction. Patients with abdominal symptoms showed higher psychological symptom scores than others. However, poor mental sanity was not related to the symptom exacerbation. CONCLUSIONS: Elective LC improves dyspeptic or colonic symptoms. Approximately 19% of patients reported continuing or exacerbated symptoms following LC. Detailed history-taking regarding gastritis before surgery can be helpful in predicting patients' outcome after LC.

Efficacy and safety of compound azintamide enteric-coated tablet in the treatment of patients with post-cholecystectomy dyspepsia:a randomized, double-blinded, placebo controlled multicentre clinical trial / 中华消化杂志

Objective To evaluate the efficacy and safety of compound azintamide enteric-coated tablet in the treatment of patients with post-cholecystectomy dyspepsia.Methods A multicentre,randomized,double-blinded,placebo-controlled trail was conducted.A total of 120 patients with post-cholecystectomy dyspepsia were divided into azintamide group (n=60) and placebo group (n＝60),taking compound azintamide enteric-coated tablet or placebo 100 mg each time,three times per day for 28 days.The score of each dyspeptic symptom (abdominal distension,loss of appetite,early satiety,belching,nausea,abdominal pain or abdominal discomfort) and total score of dyspepsia were evaluated prior to study and on the 7th,14th,21st and 28th day after treatment.The efficacy of the improvement of dyspeptic symptoms was compared between the two groups on the 28th day after treatment and the safety was evaluated.The score of the quality-of-life was compared between the two groups prior to study and on the 28th day after treatment.The t-test or chi-square test was performed for statistical analysis.Results The scores of abdominal distension,belching,nausea,abdominal pain or abdominal discomfort and the total score of azintamide group on the 7th day after treatment (5.7±3.1,3.5±2.1,0.3±0.1,3.3±1.7 and 17.9±9.6) were significantly lower than those prior to study (8.9±5.3,5.3±2.5,0.9±0.4,4.5±3.7,24.3±14.5;t=3.758,3.976,10.494,2.125 and 2.654,allP＜0.05).On the14th,21st and28thday after treatment in azintamide group,the score of each dyspeptic symptom and the total score were lower than those prior to study.The symptom of abdominal distension significantly improved on the 7th,14th,21st and 28th day after treatment in placebo group,and the score of early satiety and total score of dyspepsia were significantly lower on the 28th day after treatment compared with those before treatment.In azintamide group,the total efficacy rate was 66.7％ (40/60),which was higher than that of placebo group (38.3％,23/60) and the difference was statistically significant (x2 =9.653,P ＜ 0.01).On the 28th day after treatment,SF-NDI of azintamide group was 4.4±3.4,which was significantly lower than that of placebo group (9.6±6.0) and the difference was statistically significant (t=5.450,P＜0.01).In azintamide group there was one patient with rash on the 7th day after treatment,and in placebo group there was one patient with headache on the 14th day after treatment.The symptoms disappeared seven days after medicine withdrawal.Conclusion Compound azintamide enteric-coated tablet effectively improves dyspeptic symptoms and quality of life in patients with post-cholecysteetomy dyspepsia and has good safety.

Laparoscopic Resection for the Treatment of Symptomatic Remnant Huge Cystic Duct with Stone after Laparoscopic Cholecystectomy

During laparoscopic cholecystectomy, the cystic duct is frequently divided closer to the gallbladder to avoid iatrogenic injury to the common bile duct. Postcholecystectomy syndrome can be considered if the patient complains of right upper abdominal discomfort after cholecystectomy. We report a case of a laparoscopic resection for the treatment of a symptomatic remnant huge cystic duct with stones after a previous laparoscopic cholecystectomy. A 46-year-old male was admitted to our hospital due to right upper quadrant abdominal pain. Five years earlier, the patient had undergone a laparoscopic cholecystectomy under the diagnosis of acute calculous cholecystitis but he subsequently suffered from intermittent right upper abdominal pain and fever. An abdominal computed tomography scan revealed a stone in a dilated remnant cystic duct. A laparoscopic remnant cystic duct resection was performed and apathologic diagnosis was made with chronic calculus cystic duct inflammation. The patient was discharged without complications and has been doing well without recurrent symptoms.

Síndrome Sump: um relato de caso / Sump Syndrome: a case report

Objetivos: descrever o diagnóstico e tratamento de um caso de Síndrome Sump. Descrição do Caso: uma mulher de 33 anos vinha apresentando episódios recorrentes de dor abdominal, acompanhados de febre e calafrios. A paciente havia sido submetida previamente à cirurgia de vias biliares, sendo realizado o diagnóstico atual de Síndrome Sump. Optou-se pelo tratamento cirúrgico, diante da impossibilidade de tratamento endoscópico. Conclusões: a Síndrome Sump, entidade rara na atualidade, consiste em uma complicação da coledocoduodenoanastomose, causada pelo contato de resíduos gástricos com o colédoco distal, levando à sua obstrução. Deve ser lembrada como causa de colangite de repetição.

Aims: To describe the diagnosis and treatment of a case of Sump Syndrome. Case Description: A 33 years old woman presented recurrent episodes of abdominal pain accompanied by fever and chills. The patient had previously undergone surgery of the biliary tract, and the current diagnosis of Sump Syndrome was performed. A surgical treatment was indicated given the impossibility of endoscopic treatment. Conclusions: The Sump Syndrome, rare nowadays, consists of a complication of choledocoduodenoanastomosis caused by contact of gastric residues with the distal common bile duct, causing obstruction. It should be considered as a cause of recurrent cholangitis.

Sump syndrome: relato de caso / Sump syndrome: case report

Sump Syndrome after choledochoduodenostomy is becoming rare, mainly because endoscopic procedures are replacing this surgery. We report a case of this syndrome where the only symptom was pain. The diagnosis was made after 3 years and many doctors attended the patient. The treatment was endoscopic and the result was excellent.

Laparoscopic Removal of a Retained Gallbladder with Remnant Cystic Duct Calculi

Laparoscopic cholecystectomy has been widely performed as a gold standard in patients with symptomatic gallstone disease. To avoid bile duct injury during operation, it is recommended that dissection should be kept close to the gallbladder despite the potential risk of long cystic duct stump. Post-cholecystectomy syndrome refers to a wide spectrum of conditions that often pose a diagnostic and therapeutic dilemma for surgeon. Cystic duct remnant may cause postcholecystectomy syndrome in the presence of stones. A case is presented in which a symptomatic gallbladder remnant with gallstone was removed successfully by laparoscopic technique. In the era of laparoscopic surgery, which favors a long cystic duct remnant, we should be aware of cystic duct remnant stones as a possible cause of post-cholecystectomy syndrome.

The Clinic Value of Ultrasound in Detecting the Pathogen of Postcholecystectomy Syndrome / 重庆医科大学学报

Objective:To study the clinic value of ultrasound in detecting the pathogen of postcholecystectomy syndrome.Methods:The ultrasonograms of 301 patients were reviewed,who had their gallbladder cut or common bile duct explored(because of gallstone or other diseases) and still had some clinic symptoms after operation such as abdominal pain,dyspepsia,infection or obstruction of bile duct.Results:Among 301 cases,66 cases(21.93%) showed normal ultrasonograms and 253 cases(78.07%) showed abnormal ultrasonograms of liver or bile duct.Namely:1.156 cases with light simplex choledochectasia(51.82%);2.54 cases with light simplex choledochectasia and intrahepatic duct dilation(17.94%);3.23 cases with choledochectasia and abnormal anechoic area instead of cholecyst image(6.64%).4.1 case with choledochectasia and calculus of intrahepatic duct(0.33%);5.1 case with apparent choledochectasia and calculus of the lower part of common bile duct(0.33%).Conclusion:Ultrasound has higher clinic value in detecting the pathogen of postcholecystectomy syndrome.

Vesícula residual / Residual gallbladder

Our objective is to report three patients with recurrent severe upper abdominal pain secondary to residual gallbladder. All patients had been subjected to cholecystectomy from 1 to 20 years before. The diagnosis was established after several episodes of severe upper abdominal pain by imaging exams: ultrasonography, tomography, or endoscopic retrograde cholangiography. Removal of the residual gallbladder led to complete resolution of symptoms. Partial removal of the gallbladder is a very rare cause of postcholecystectomy symptoms.

Postcholecystectomy syndrome: Etiology and management / 中国微创外科杂志

Objective To study the etiology and the management of postcholecystectomy syndrome (PCS). Methods A review of 148 cases of PCS was made. Results Positive signs existed in 111 cases. Seventy-eight cases underwent operations with complete cure in 74 cases and improvement in 4 cases, whereas the other 70 cases received conservative therapies with complete cure in 9 cases, improvement in 48 cases and no change in the remaining 13 cases. Conclusions PCS is a series of symptoms with complicated reasons. Prevention should be put first.

Endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome / 中华消化内镜杂志

Objective To approach the treatment value of endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome.Methods Endoscopic sphincterotomy was undergone in 28 cases with ultimate diagnosis of Oddi sphincter dysfunction after BUS, ERCP , basal sphincter pressure examination and ruled out the patients with retained or recurrent stones,stricture or carcinoma in the bile duct having postcholecystectomy syndrome.Results Symptoms disappeared completely after the treatment in 18 cases,alleviated apparently in 5 cases and other 2 cases after the second treatment,without alleviation in 3 cases,the effective rate is 89.3%(25/28).No severe complication happened.Conclusion It is assumed that endoscopic sphincterotomy is a micro-traumatic,safe and effective treatment for the dysfuction of Oddi sphincter in postcholecystectomy syndrome.