Álvarez-Sánchez Guillermo, Del Valle Diana D, Maydón-González Hernán Gustavo, Pérez-Aguilar Francisco
Centro Hospitalario Nuevo Sanatorio Durango, Servicio de Cirugía General. Ciudad de México, México.
Beth Israel Deaconess Medical Center, Surgery Division. Boston, Massachusetts, United States of America.
Rev Med Inst Mex Seguro Soc. 2022 May 2;60(3):350-355.
Subtotal cholecystectomy was described in 1985 as an alternative to total cholecystectomy in cases of difficult cholecystectomy. It was classified as reconstituted and fenestrated subtotal. In spite of being a viable alternative, up to 10.6% of biliary leakage is reported and 2.2% of patients present with cholecystitis of the gallbladder remnant. The objective of this report is to describe and emphasize the importance of an adequate diagnosis of complications in patients with a history of subtotal cholecystectomy.
72-year-old male with a history of open subtotal cholecystectomy 6 years prior to his admission to the emergency department due to right hypochondrium pain and vomiting. He had a history of biliary pancreatitis and choledocholithiasis after subtotal cholecystectomy resolved by endoscopic retrograde cholangiopancreatography (ERCP). It was decided to admit the patient and a diagnosis of cholecystitis of the gallbladder remnant was made. Laparoscopic cholecystectomy of the remnant was performed with subsequent clinical resolution.
Although subtotal cholecystectomy may be the only option in cases of difficult cholecystectomy, it may result in future complications. The possibility of more complex surgical reinterventions should be considered. Our case report demonstrates that total cholecystectomy in cases of cholecystitis should be performed whenever possible to avoid potential complications caused by subtotal cholecystectomy.
1985年，次全胆囊切除术被描述为难治性胆囊切除术病例中全胆囊切除术的替代方法。它被分类为重建性和开窗性次全切除术。尽管它是一种可行的替代方法，但据报道胆漏发生率高达10.6%，2.2%的患者出现胆囊残余胆囊炎。本报告的目的是描述并强调对有次全胆囊切除术病史患者并发症进行充分诊断的重要性。
一名72岁男性，因右季肋部疼痛和呕吐入住急诊科，6年前有开放性次全胆囊切除术史。他有胆源性胰腺炎病史，次全胆囊切除术后胆总管结石经内镜逆行胰胆管造影（ERCP）解决。决定收治该患者，诊断为胆囊残余胆囊炎。对残余胆囊进行了腹腔镜胆囊切除术，随后临床症状缓解。
尽管次全胆囊切除术可能是难治性胆囊切除术病例中的唯一选择，但它可能导致未来并发症。应考虑更复杂手术再次干预的可能性。我们的病例报告表明，对于胆囊炎病例，应尽可能进行全胆囊切除术，以避免次全胆囊切除术引起的潜在并发症。
