Unexplained pain in the gallbladder area: Possible origins and further details
Understanding Post-Cholecystectomy Syndrome: Causes, Symptoms, and Treatments
The gallbladder, a small organ located in the upper right abdomen, plays a crucial role in fat digestion. After a cholecystectomy, the removal of the gallbladder, some individuals may experience persistent symptoms known as post-cholecystectomy syndrome (PCS).
While common causes of PCS include irritable bowel syndrome (IBS), peptic ulcers, chronic pancreatitis, and gastroesophageal reflux disease (GERD), there are other less recognised factors that can contribute to PCS symptoms.
Causes of PCS
Biliary strictures or bile duct injury, retained or recurrent bile duct stones (choledocholithiasis), sphincter of Oddi dysfunction, bile reflux gastritis, neuropathic pain, functional biliary disorders, and rarer complications such as biliary-enteric fistula formation, post-surgical adhesions, or bile leaks are potential causes of PCS [1][5].
Injury or scarring of the bile ducts during surgery can lead to bile flow obstruction, causing pain similar to gallbladder colic. Stones left behind or newly formed in the bile ducts after gallbladder removal can cause pain and jaundice. Abnormal motility or spasm of the muscle controlling bile flow can cause recurrent biliary-type pain. Backflow of bile into the stomach after cholecystectomy may cause epigastric pain and dyspepsia. Nerve injury or central sensitization may contribute to persistent pain despite the absence of the gallbladder. Abnormalities in bile flow without clear obstruction are also possible causes.
Symptoms of PCS
Symptoms of PCS may vary depending on the underlying cause. Common symptoms include indigestion, nausea and vomiting, abdominal colic, fever, and jaundice [1][5]. The most common issues in PCS are indigestion or nonspecific symptoms rather than true biliary colic. PCS may manifest with symptoms similar to biliary colic or pain in the right upper quadrant of the abdomen.
Diagnosis and Treatment
Healthcare professionals will make a diagnosis and create a treatment plan for PCS based on the underlying cause. Diagnostic tests for PCS may include a complete blood count, comprehensive metabolic panel blood tests, blood gas test, X-rays, or ultrasound scans. In some cases, an upper gastrointestinal endoscopy may be performed to help identify the cause behind early PCS symptoms.
Treatments for PCS may include medications such as bulking agents, sedatives, antispasmodics, cholestyramine, antacids, proton pump inhibitors, or histamine-2 blockers, depending on the cause of symptoms [1]. Surgical treatment options for PCS may include endoscopic retrograde cholangiopancreatography, endoscopic stone extraction, or removal of the remaining cystic duct.
Prevention and Awareness
Understanding potential complications and the possible signs and symptoms of PCS may help people identify any issues that arise after a cholecystectomy procedure. If you have had a cholecystectomy and experience any unexpected symptoms, it is essential to contact a doctor immediately.
[1] Boudghene, K., et al. (2015). Post-cholecystectomy syndrome: mechanisms, diagnosis, and management. World Journal of Gastroenterology, 21(41), 12212-12222. [5] Hwang, J. H., et al. (2016). Postcholecystectomy syndrome: a review. Annals of Surgical Oncology, 23(12), 3999-4007.
- Besides gallbladder removal, other factors can contribute to post-cholecystectomy syndrome (PCS), such as biliary strictures or bile duct injury.
- PCS symptoms may include indigestion, nausea and vomiting, abdominal colic, fever, and jaundice.
- In some cases, stones left behind or newly formed in the bile ducts can cause pain and jaundice.
- Abnormal motility or spasm of the muscle controlling bile flow can lead to recurrent biliary-type pain.
- Backflow of bile into the stomach after cholecystectomy may cause epigastric pain and dyspepsia.
- Nerve injury or central sensitization may contribute to persistent pain after the removal of the gallbladder.
- Abnormalities in bile flow without clear obstruction are potential causes of PCS.
- Healthcare professionals will use diagnostic tests to ensure an accurate diagnosis of PCS and create a treatment plan.
- Treatments for PCS may include medications like bulking agents, sedatives, antispasmodics, cholestyramine, antacids, proton pump inhibitors, or histamine-2 blockers.
- In some cases, endoscopic retrograde cholangiopancreatography, endoscopic stone extraction, or removal of the remaining cystic duct may be necessary.
- People who have had a cholecystectomy should be aware of potential complications and the possible signs and symptoms of PCS.
- If you have had a cholecystectomy and experience any unexpected symptoms, it is essential to contact a doctor immediately.
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