A certain percentage of people who have undergone a cholecystectomy (surgery to remove the gallbladder) continue to suffer from some of their presurgical symptoms, a condition known as post-cholecystectomy syndrome (PCS). In most cases, PCS symptoms are not severe and either subside on their own or are controlled well with medication. In some few cases, however, symptoms persist or even become increasingly severe, and another surgical procedure is necessary.
Causes of PCS
The causes of symptoms of gallbladder disease persisting after surgery are not completely clear. There is speculation that diarrhea may result from an increase of bile, perhaps due to leakage, into the colon, where it may work as a laxative. When the onset of the syndrome occurs early in the post-operative period, it is often caused by incomplete surgery, meaning that some small stones may remain in either the cystic duct or the bile duct.
Occasionally, symptoms may be the result of an injury to one of the ducts during the previous surgical procedure. A common cause of symptoms that occur months, or even years, after surgery, is sphincter of Oddi dysfunction, in which the muscle surrounding the end of the pancreatic and bile ducts does not contract and relax normally. In some cases, episodes of pain are provoked by particular medications, especially opioids.
Symptoms of PCS
The symptoms of PCS are similar to the symptoms of gallbladder disease, but typically not as severe. They may consist of one or more of the following:
- Dyspepsia (belching, discomfort, bloating)
- Pain in the abdomen or upper back
- Fever (rarely)
In worst cases episodes, patients suffering from PCS experience pain as severe as that provoked by actual gallbladder attacks.
Diagnosis of PCS
In many cases, doctors diagnose this syndrome through medical history and examination, noting gastrointestinal symptoms following gallbladder surgery. They may treat the disorder with mild medications without further testing. When confirmation of a diagnosis is necessary, particularly if reparative surgery is being considered, one or more of the following diagnostic imaging tests may be administered:
- Abdominal ultrasound or CT scan
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Magnetic resonance cholangiography (MRCP)
- Manometry of the sphincter of Oddi
- Biliary scintigraphy
It is possible that the symptoms experienced after gallbladder surgery result from other gastrointestinal causes unrelated to the cholecystectomy. These tests may help to diagnose another reason for the patient's symptoms, or the symptoms may be idiopathic.
Treatments of PCS
Treatments for post-cholecystectomy syndrome may include dietary restriction of caffeine, dairy products, fatty foods and sweets and administration of one or more of the following:
- Anti-diarrheal medications
- Medications that impair absorption of bile acids (sequestrants)
- Medications that relieve gastrointestinal muscle spasms (anticholinergics)
When symptoms are severe, and diagnostic tests show cause, a surgical procedure may be necessary. Surgeries that may be performed to correct post-cholecystectomy syndrome include:
- Placement of a biliary stent
- Drainage of bile accumulated in the abdominal cavity
When an endoscopic cholangiopancreatography is performed, certain repairs to the region can be accomplished during the same procedure. These include widening of strictures, removing obstructions and, sometimes, inserting stents.