Post-cholecystectomy syndrome. Now the gallbladder has been removed. Persistent right
upper quadrant pain with nausea and vomiting after cholecystectomy that mimics preop
symptoms. You will find these in a number of your patients and if you have not properly
educated your patient, they have no idea what's going on because they don't know what to
expect. But if you tell them, follow up and say listen "There's every possibility, I have just
performed the surgery, I removed your gallbladder, this is why you needed it but the body will
take a little bit of time to adapt so therefore you might still have the same symptoms as
what you're experiencing prior." Important that you know the definition. It happens more often than we would like.
Some of the possible etiologies for this syndrome include papillary stenosis,
a retained stone that wasn't removed during the surgery,
an injury to the common bile duct or biliary dyskinesia, which is a motility disorder of the biliary tree
often caused by hypertonic sphincter of oddi preventing the empty of the bile duct contents into the duodenum.
The workup of this syndrome usually starts with an ultrasound or a CT to identify retained stone.
An ERCP can also be helpful in these situations. It'll be diagnostic for bile duct injurie
and the sphincterotomy will be therapeutic for both the retained stone or a hypteronic sphincter of oddi.