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Tuesday, April 12, 2011

POSTCHOLECYSTECTOMY SYNDROME

Symptoms following cholecystectomy occur in 12-68% of patients depending on how thecondition is defined, how actively symptoms are sought, and the indications for cholecystectomy.
 when cholecystectomy is performed for acute calculous. cholecystitis at least 70% of patients remain symptom-free. Postcholecystectomy symptoms occur most frequently in women, In patients who have a history longer than 5 years prior to cholecystectomy, and in patients in whom the operation was undertaken for non-calculous gallbladder disease.
Causes of postcholecystectomy symptoms
Immediate post-surgical
  • Trauma
  • Bleeding
  • Biliary peritonitis
  • Abscess
  • Fistula
Biliary
  • Common bile duct stones
  • Benign stricture
  • Tumour
  • Cystic duct sump syndrome
  • Papillary disorders
Extra biliary
  • Flatulent dyspepsia syndrome
  • peptic ulcer
  • pancreatic disease
  • Hiatus hernia
  • Irritable bowel syndrome
  • Functional abdominal pain
The usual complaints include right upper quadrant pain, flatulence, fatty food intolerance, and occasionally jaundice and cholangitis. Liver function tests may be abnormal and sometimes show cholestasis. ultrasonagraphy is used to detect biliary obstruction, and retrograde cholangiopancreatography is usually needed. Other investigations which may be requires include barium studies of the gastrointestinal tract, pancreatic function tests, cholescintigraphy and a liver biopsy. If all of these tests are unhelpful the question of psychiatric illness should be considered.
Management depends on demonstrating a cause frequently no intrabdominal disease is found and the patient is managed with advice regarding a low fat diet, the use of antacid preparations, and treatment for the irritable bowel syndrome depending on the nature of the symptoms which patient is presenting.

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