Postcholecystectomy syndrome: biliary-related complications.

In Italy, about 100,000 cholecystectomies are carried out annually, the majority of them laparoscopically. Complications following cholecystectomy are common and increase morbidity and cost burden. Biliary damage (0.08-0.5%), bile leak (0.42-1.1%), retained common bile duct stones (0.8-5.7%), postcholecystectomy syndrome (10-15%), and postcholecystectomy diarrhea (5-12%) are a few of the most often occurring laparoscopic cholecystectomy consequences. In many instances, endoscopy can offer conclusive management and is crucial for the identification and treatment of biliary problems. Regarding the ideal treatment strategy for biliary problems, there is no universal agreement. A skilled interdisciplinary team should therefore approach biliary problems. The surgeon must be knowledgeable on how to handle these issues.

[Splenic artery aneurysm masked by postcholecystectomy syndrome]. / Anevrizma selezenochnoi arterii pod maskoi postkholetsistéktomicheskogo sindroma.

Visceral artery aneurysms appear to belong to uncommon and potentially lethal vascular diseases. They are usually revealed accidentally during an ultrasonographic examination, magnetic resonance imaging, or computed tomography. Described in the article is a clinical case report concerning a sacciform aneurysm of the splenic artery, detected in a 53-year-old woman presenting with postcholecystectomy syndrome and followed up for abdominalgia by therapeutists and gastroenterologists. Timely performed radiodiagnosis (including multispiral computed tomography and angiography of the abdominal vessels) made it possible not only to detect the aneurysm, having thus verified the volumetric formation previously found on ultrasonographic examination, but to take adequate measures aimed at preventing rupture of the aneurysm and consisting in endovascular occlusion of the aneurysmatic cavity with metal spirals. Lack of complete clarity in the understanding of the mechanisms of the origin of and no distinctly defined therapeutic-and-diagnostic algorithm for visceral artery aneurysms dictate the necessity to continue collecting and generalizing clinical case reports regarding this rarely encountered vascular pathology.

[The consequences of cholecystectomy]. / Posledstviya kholetsistektomii (s kommentariem).

AIM: to analyze the consequences of cholecystectomy. MATERIAL AND METHODS: 348 patients were under observation within 10  years after cholecystectomy. Surgery for destructive and chronic cholecystitis was performed in 115 and 233 patients respectively. The consequences of cholecystectomy were assessed using bile acids level in blood plasma, stomach and duodenal pressure, pancreatic and stomach changes. RESULTS AND DISCUSSION: It was established that lithocholic, deoxycholic, taurodeoxycholic acids were increased by 44% within 10 years after surgery. At the same time glycocholic and tauroursodeoxycholic acids were decreased by 21.5% in 5 years after surgery. Bile acids level changes were associated with changes of stomach and duodenal pressure. The most pronounced disorders were observed in distal duodenum. There was more than 2.8-fold excess of normal pressure in this area. Duodenal hypertension was accompanied by pancreatic ducts enlargement in 9.5% of cases and increased echogenicity in 93% of cases. CONCLUSION: Changes of the level and proportion of blood plasma bile acids and hypertension in upper gastrointestinal tract are the most important in chronic pancreatitis pathogenesis after cholecystectomy. Such conditions occur within first 3 years after surgery.

[Postcholecystectomy syndrome in children (case report)].

The article presents the case of the development of the postcholecystectomical syndrome in a child with a gallstone disease after cholecystectomy. It describes the clinical picture of the postcholecystectomical syndrome, identifies laboratory changes, characteristic for the postcholecystectomical syndrome in children. The aim of this work was to show the clinical example of the difficulty of detecting signs of the postcholecystectomical syndrome in children for the optimization of the diagnostic tactics.

Stump stone 6 years after cholecystectomy: a possibility.

Calculi in the cystic duct remnant are one of the causes of postcholecystectomy syndrome. A 36-year-old woman presented thrice to the casualty department with right upper quadrant pain at an interval of 2 months every time. Ultrasound and CT scan of the abdomen was normal except for echoes in the gallbladder region may be clips. She was treated conservatively and discharged the first two times. The second time, the MR cholangiopancreatography was normal. She had undergone endoscopic retrograde cholangiopancreatography with sphincterotomy with stent in situ outside elsewhere before presenting to us for the third time, which was removed after 6-weeks. The third time, she was taken up for laparoscopic stump exploration, which revealed a stone, which was the cause of her pain. To conclude, stump stone can be a possibility of post cholecystectomy syndrome even after 6 years, and surgeons should be aware of it.

Gallstone disease in children.

Gallstone disease in children is evolving, and for the previous 3 decades, the frequency for surgery has increased greatly. This is in part because of improved diagnostic modalities, but also changing pathology, an increased awareness of emerging comorbidities, such as childhood obesity, and other associated risk factors. This article outlines the pathophysiology, genetics, and predisposing factors for developing gallstones and includes a review of the literature on the current and more novel medical and surgical techniques to treat this interesting disease.

Clinical features and treatment of sump syndrome following hepaticojejunostomy.

BACKGROUND: Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture. A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome). Despite prophylactic rotating antibiotic therapy, the cholangitic episode may be severe and life-threatening. METHODS: From 2001 to 2006, six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary sepsis. Anastomotic stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC). Barium meal showed reflux of contrast into the biliary tree in all patients. Three patients had a short jejunal Roux limb (less than 50 cm) on pre-operative imaging. RESULTS: Five patients underwent surgery and two of them had two operations. One patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux loop. Three patients had lengthening of the Roux loop; one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux loop. The latter underwent further lengthening of the Roux loop. Three patients are cholangitis-free 6, 36 and 60 months after surgery; two still experience mild episodes of cholangitis. CONCLUSIONS: An adequate length of the Roux loop is important to prevent reflux. However, Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis, although generally less frequent and severe, may recur despite appropriate reconstructive or antireflux surgery. In these cases, life-long rotating antibiotics is the only available measure.

Post-cholecystectomy Mirizzi's syndrome: magnetic resonance cholangiopancreatography demonstration.

A long cystic duct remnant may be found after laparoscopic cholecystectomy. Stone may form in the remnant cystic duct and can cause postcholecystectomy syndrome. Remnant cystic duct calculus may rarely result in postcholecystectomy Mirizzi's syndrome. Traditionally, Mirizzi's syndrome has been diagnosed with endoscopic retrograde cholangiopancreatography (ERCP) and treated with open surgery. We report a case of postcholecystectomy Mirizzi's syndrome that developed 3 years after laparoscopic cholecystectomy. A non-invasive diagnosis of Mirizzi's syndrome was made comprehensively by magnetic resonance cholangiopancreatography. Endoscopic stone removal was achieved successfully with ERCP without any complication.

Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography.

Post-cholecystectomy syndrome (PCS) is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. Nevertheless, this term is inaccurate, as it encompasses biliary and non-biliary disorders, possibly unrelated to cholecystectomy. Biliary manifestations of PCS may occur early in the post-operative period, usually because of incomplete surgery (retained calculi in the cystic duct remnant or in the common bile duct) or operative complications, such as bile duct injury and/or bile leakage. A later onset is commonly caused by inflammatory scarring strictures involving the sphincter of Oddi or the common bile duct, recurrent calculi or biliary dyskinesia. The traditional imaging approach for PCS has involved ultrasound and/or CT followed by direct cholangiography, whereas manometry of the sphincter of Oddi and biliary scintigraphy have been reserved for cases of biliary dyskinesia. Because of its capability to provide non-invasive high-quality visualisation of the biliary tract, magnetic resonance cholangiopancreatography (MRCP) has been advocated as a reliable imaging tool for assessing patients with suspected PCS and for guiding management decisions. This paper illustrates the rationale for using MRCP, together with the main MRCP biliary findings and diagnostic pitfalls.

[Pathogenetic and diagnostic aspects of postcholecystectomy syndrome].

In the review up-to-date information about postcholecystectomy syndrome was adduced. The main underlying pathogenetic links of different functional disturbs and organic pathology were considered. Necessity of this nosologic unit common diagnostic algorithm elaboration was proved by own and literature data analysing.