Background and study aims: Stones in the cystic duct stump (CDS) or gallbladder remnant after cholecystectomy are difficult to identify. The aim of this study was to evaluate the utility of endoscopic ultrasound (EUS) in the diagnosis of stones in the CDS or gallbladder remnant in patients with postcholecystectomy syndrome.
Methods: A prospective study was conducted between January 2011 and December 2012 in consecutive patients with pancreaticobiliary-type pain or acute pancreatitis (n = 112) following cholecystectomy. Diagnostic modalities including EUS were used to diagnose the cause of postcholecystectomy syndrome.
Results: A total of 11 patients (10 %) were found to have stones in the gallbladder remnant (n = 8), CDS (n = 2), or both (n = 1). In eight patients, EUS was the first imaging procedure to make the diagnosis. Seven patients agreed to undergo repeat surgery, and six of them remained free of symptoms postoperatively after a median follow-up period of 4 months (range 1 – 13 months).
Conclusion: EUS may be an important procedure to consider in the study of patients with symptoms after cholecystectomy, as the diagnosis of residual stones is frequently missed by other imaging modalities.
References
1 Girometti R, Brondani G, Cereser L et al. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. Br J Radiol 2010; 83: 351-361
3 Anand AC, Sharma R, Kapur BM et al. Analysis of symptomatic patients after cholecystectomy: is the term post-cholecystectomy syndrome an anachronism?. Trop Gastroenterol 1995; 16: 126-131
9 Samuel E. The radiological anatomy of the biliary passages with especial reference to the post-cholecystectomy syndrome. Ann R Coll Surg Engl 1957; 20: 157-176
11 Bodvall B, Overgaard B. Cystic duct remnant after cholecystectomy: incidence studied by cholegraphy in 500 cases, and significance in 103 reoperations. Ann Surg 1966; 163: 382-390
17 Catalano MF, Sahai A, Levy M et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009; 69: 1251-1261
21 Walsh RM, Chung RS, Grundfest-Broniatowski S. Incomplete excision of the gallbladder during laparoscopic cholecystectomy. Surg Endosc 1995; 9: 67-70
23 Maingot R. Complications of cholecystectomy. Lecture delivered at the Royal College of Surgeons of England on 25th September 1962. Ann R Coll Surg Engl 1963; 32: 42-58
24 Shamiyeh A, Danis J, Wayand W et al. A 14-year analysis of laparoscopic cholecystectomy: conversion – when and why?. Surg Laparosc Endosc Percutan Tech 2007; 17: 271-276
25 Kaafarani HM, Smith TS, Neumayer L et al. Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 2010; 200: 32-40
26 Calvo MM, Bujanda L, Heras I et al. Magnetic resonance cholangiography versus ultrasound in the evaluation of the gallbladder. J Clin Gastroenterol 2002; 34: 233-236
