Ben Hmida Wafa, Jerraya Hichem, Nasseh Souhir, Haloui Nabil, Khalfallah Mehdi, Nouira Ramzi
Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia.
Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia.
Int J Surg Case Rep. 2021 Jun;83:105950. doi: 10.1016/j.ijscr.2021.105950. Epub 2021 Apr 30.
Although the symptoms attributed to gall stones resolve in most patients after cholecystectomy, some may have symptoms that persist or recur. It is known as the post-cholecystectomy syndrome (PCS). The aim of this case was to describe the diagnostic difficulties encountered and to discuss the main etiologies of this entity.
A 54-year-old man presented for a recurrent right upper quadrant pain despite laparoscopic cholecystectomy five years ago. Imaging showed cystic lesion at the gallbladder fossa with gallstones. We decided to reoperate the patient by laparoscopic approach. It turned to be a residual gallbladder with stones inside. It was confirmed by histopathology. He was asymptomatic after a follow-up of 2 years.
The PCS should not be trivialized. Most of the causes are allocated to extra biliary etiologies. They must be ruled out first as most of them can be controlled with medication. There are etiologies for which re-operation can be necessary.
The indication of cholecystectomy must be taken wisely otherwise surgery will not solve the problem. Even though patient may complain of persistence or recurrence of the pain. In this case, it can be a real challenge for both diagnosis and treatment.
尽管大多数胆结石患者在胆囊切除术后症状会缓解,但仍有一些患者的症状会持续或复发。这被称为胆囊切除术后综合征(PCS)。本病例的目的是描述所遇到的诊断困难,并讨论该病症的主要病因。
一名54岁男性,尽管5年前已行腹腔镜胆囊切除术,但仍反复出现右上腹疼痛。影像学检查显示胆囊窝有囊性病变并伴有胆结石。我们决定通过腹腔镜手术对该患者进行再次手术。结果发现是一个残留胆囊,内部有结石。经组织病理学证实。随访2年后他无症状。
不应轻视PCS。大多数病因归因于非胆道病因。必须首先排除这些病因,因为其中大多数可以通过药物控制。有些病因可能需要再次手术。
必须明智地把握胆囊切除术的指征,否则手术无法解决问题。即使患者可能抱怨疼痛持续或复发。在这种情况下,诊断和治疗都可能是一项真正的挑战。