Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA.
Department of Radiology, University of California San Diego, San Diego, CA, USA.
J Hepatobiliary Pancreat Sci. 2019 Apr;26(4):137-143. doi: 10.1002/jhbp.613. Epub 2019 Apr 3.
Patients can present with symptomatic gallbladder disease after cholecystectomy due to a remnant gallbladder. This is a rare problem and challenging diagnosis with limited prior characterization; thus, we present a large series of patients with a gallbladder remnant.
A retrospective review was performed of all patients presenting with symptomatic gallbladder remnant at a tertiary care center from 2002 to 2016. Data on presenting symptoms, diagnostic tests, treatments, and follow-up were collected.
Thirty-one patients diagnosed and treated for a symptomatic gallbladder remnant were identified. The most common presenting symptoms included right upper quadrant pain (87%) and nausea (55%). The median time from symptom presentation to definitive diagnosis was 60 days. Diagnostic modalities utilized in the evaluation of these patients demonstrated that endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were effective with sensitivities of 85% and 90%, respectively. Twenty-three (76.2%) patients underwent completion cholecystectomy, which proved to be definitive treatment. Additionally, eight (25.8%) patients were non-operative candidates and underwent endoscopic retrograde cholangiopancreatography and sphincterotomy, three of whom developed recurrent symptoms.
A symptomatic gallbladder remnant after cholecystectomy is infrequently seen; however, the diagnosis should be considered in patients with recurrent biliary symptoms after cholecystectomy. Completion cholecystectomy can be challenging but is highly effective for definitive treatment.
患者在胆囊切除术后可能会因残余胆囊而出现有症状的胆囊疾病。这是一个罕见的问题，诊断具有挑战性，且之前的特征有限；因此，我们提出了一系列具有残余胆囊的患者。
对 2002 年至 2016 年期间在三级护理中心因有症状的残余胆囊就诊的所有患者进行了回顾性分析。收集了有关就诊症状、诊断测试、治疗和随访的资料。
确定了 31 例因有症状的残余胆囊而接受诊断和治疗的患者。最常见的就诊症状包括右上腹痛（87%）和恶心（55%）。从症状出现到明确诊断的中位数时间为 60 天。用于评估这些患者的诊断方式表明，内镜逆行胰胆管造影术和磁共振胰胆管造影术的敏感性分别为 85%和 90%，效果有效。23 例（76.2%）患者接受了根治性胆囊切除术，这被证明是明确的治疗方法。此外，8 例（25.8%）患者不适合手术，接受了内镜逆行胰胆管造影术和括约肌切开术，其中 3 例出现了症状复发。
胆囊切除术后出现有症状的残余胆囊很少见；然而，对于胆囊切除术后有复发性胆道症状的患者，应考虑诊断该疾病。根治性胆囊切除术可能具有挑战性，但对明确治疗非常有效。
