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DOI: 10.1055/s-2004-814254
Insufficient Cholecystectomy Diagnosed by Endoscopic Ultrasonography
Publication History
Submitted 30 January 2003
Accepted after Revision 9 July 2003
Publication Date:
26 February 2004 (online)
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Recurrent attacks of upper right quadrant pain after cholecystectomy are not infrequent. In most of these cases, the cause of the pain remains undiagnosed. Insufficient cholecystectomy has been described as a rare cause of post-cholecystectomy pain, although the true incidence is unknown. It is difficult to diagnose a residual gallbladder or a large cystic duct with residual stones, due to the size of the remaining structures. This report presents three patients who had experienced a long period of agonizing biliary-type pain after cholecystectomy. Abdominal ultrasound examinations, and magnetic resonance cholangiopancreatography (MRCP) in one patient, were normal. Endoscopic ultrasonography (EUS) demonstrated the presence of a small cystic structure with echogenic foci compatible with a residual gallbladder containing small gallstones. Two of the three diagnoses were confirmed by repeat surgery. EUS thus appears to be a valuable method for diagnosing insufficient cholecystectomy, and should be considered in patients with persistent pain attacks after cholecystectomy.
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H. Hassan, M. D.
Rødovrevej 200, 2. TH · 2610 Rødovre · Denmark
Email: hazim@dadlnet.dk