Postcholecystectomy syndrome

Presentation

Symptoms of postcholecystectomy syndrome may include:

• Dyspepsia, nausea and vomiting.
• Flatulence, bloating and diarrhea.
• Persistent pain in the upper right abdomen.

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 a gallbladder, bile enters the intestine constantly, but in small quantities. Thus, it may be insufficient for the digestion of fatty foods. Postcholecystectomy syndrome treatment depends on the identified violations that led to it. Typically, the patient is recommended a dietary restriction table with fatty foods, enzyme preparations, antispasmodics, and sometimes cholagogue.

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

A trial of bile acid sequestrant therapy is recommended for bile acid diarrhea.

Functional dyspepsia is subdivided into Epigastric Distress Syndrome (EPS) and Post-Prandial Distress Syndrome (PDS). Treatment for EPS and PDS can both include proton pump inhibitors and dopamine antagonists. Tricyclic antidepressants have also been proven effective for nausea, vomiting, early satiety, impaired motility and other related symptoms.

When investigation reveals no abnormalities within the abdominal cavity, the attending physician may consider Anterior cutaneous nerve entrapment syndrome (ACNES) as a possible cause. ACNES may present with pseudovisceral symptoms, including nausea, bloating, diarrhea and early satiety.

References

References

1. "Postcholecystectomy syndrome". WebMD.
2. (October 2011). "Postcholecystectomy diarrhea: What relieves it?". The Journal of Family Practice.
3. (December 1992). "Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test". The American Journal of Gastroenterology.
4. (December 1990). "Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome". Hepatogastroenterology.
5. (July 2008). "Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis". Gastrointestinal Endoscopy.
6. (28 March 2012). "Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder.". World Journal of Gastroenterology.
7. (February 2010). "Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function". Clinical Gastroenterology and Hepatology.
8. (2016). "Review article: bile acid diarrhoea - pathogenesis, diagnosis and management". Aliment. Pharmacol. Ther..
9. nhs.uk, [http://www.nhs.uk/Conditions/Laparoscopiccholecystectomy/Pages/Riskspage.aspx Complications of a gallbladder removal]
10. (2013). "Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness". Surg Endosc.
11. (July 2013). "Overlap between postprandial distress and epigastric pain syndromes in functional dyspepsia: its implications for research and clinical practice (am j gastroenterol 2013;108:767-774)". Journal of Neurogastroenterology and Motility.
12. (February 2010). "Antidepressants in functional dyspepsia". Expert Review of Gastroenterology & Hepatology.
13. (August 2001). "The Abdominal Wall: An Overlooked Source of Pain". American Family Physician.