Zahedian Ali, Ahangar Sekineh Kamali, Asghari Yasser
Clinical Research Development Center, Shahid Beheshti Hospital, Sargord Ghasemi Street, Shahid Keshvari Square, Babol, Mazandaran, Iran.
Clinical Research Development Center, Shahid Beheshti Hospital, Sargord Ghasemi Street, Shahid Keshvari Square, Babol, Mazandaran, Iran.
Int J Surg Case Rep. 2018;42:145-147. doi: 10.1016/j.ijscr.2017.12.001. Epub 2017 Dec 9.
Cholecystectomy is the standard treatment for symptomatic gallbladder stone disease. However, symptoms such as abdominal pain and dyspepsia may persist even after surgery, if the gallbladder is incompletely removed known as postcholecystectomy syndrome.
A 55-year-old man with a history of open cholecystectomy presented with a complaint of recurrent pain on his upper abdomen. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed a cystic structure in the gallbladder fossa, with a filling defect at the midpoint of the cystic duct, suggesting a retained stone in the cystic duct and residual gallbladder. Therefore, he underwent completion laparoscopic cholecystectomy. He had an uneventful postoperative period with relief of the recurrent pain.
Proper dissection and identification of the gallbladder and cystic duct junction is necessary for complete removal of the gallbladder and preventing postcholecystectomy syndrome. Patients with a retained stone in the residual gallbladder should undergo surgery, and the laparoscopic method can be performed by a surgeon with expertise in this revision surgery.
In post-cholecystectomy syndrome, symptomatic Patients with retained stone in partially removed gall bladder by open method needs laparoscopic cholecystectomy by an expert surgeon to relieve their symptoms.
胆囊切除术是有症状胆囊结石疾病的标准治疗方法。然而,如果胆囊切除不完全,腹痛和消化不良等症状可能在术后持续存在,这被称为胆囊切除术后综合征。
一名有开腹胆囊切除术病史的55岁男性,因上腹部反复疼痛前来就诊。腹部超声和磁共振胰胆管造影显示胆囊窝有一个囊性结构,在胆囊管中点有一个充盈缺损,提示胆囊管内有残留结石和残余胆囊。因此,他接受了腹腔镜胆囊切除术。术后恢复顺利,反复疼痛缓解。
正确解剖和识别胆囊与胆囊管交界处对于完全切除胆囊和预防胆囊切除术后综合征是必要的。残余胆囊内有残留结石的患者应接受手术,腹腔镜手术可由擅长此类翻修手术的外科医生进行。
在胆囊切除术后综合征中,通过开放手术部分切除胆囊后有残留结石且有症状的患者需要由专业外科医生进行腹腔镜胆囊切除术以缓解症状。