VOLUME 32 - NUMBER 6-7 - 2011

Laparoscopic treated so-called reformed gallbladder in patient with postcholecystectomy chronic pain

  • Selvaggi F., Di Bartolomeo N., De Iuliis I., Del Ciotto N., Innocenti P.
  • Methods, Techniques, Drugs, 335-337
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  • Introduction. Inadequate calculi removal, bile stasis, inflammation and strictures are causes of postcholecystectomy biliary syndrome. A cystic duct remnant is defined as a residual duct greater than 1 cm; it may predispose to chronic postcholecystectomy symptoms.

    Case report. We describe a case of a 33-years-old woman with recurrent epigastric pain radiating to right back. In the past medical history, an uncomplicated cholecystectomy was reported 11 years earlier. Imaging demonstrated a 2 cm impacted calculus within a cystic duct remnant, mimicking a so-called reformed gallbladder. At the magnetic resonance imaging the biliary tract was regular without dilatation. The patient was scheduled to laparoscopic exploration. Intraoperatively, the cystic duct stump containing the impacted calculus was easily found and meticulously dissected from extrahepatic bile structures.

    Conclusion. In our experience the laparoscopic removal was safely performed with complete cystic duct remnant excision and definitive cure of chronic painful symptoms. Therefore we think that, in selected cases, the reoperation is feasible by means of mininasive surgical procedures.

  • KEY WORDS: Post-cholecystectomy pain - Cystic duct remnant - Laparoscopic cholecystectomy - Chronic pain.