Postcholecystectomy syndrome
Postcholcystectomy syndrome is the coocurence of abdominal symptoms after cholecystectomy
Post cholecystectomy syndrome occurs in 5 to 40% patients,however most symptoms are dyspepsia or otherwise nonspecific rather than true biliary colic.
Some cases have another cause (eg retained bile duct stone,pancreatitis, gastroesophageal reflux)
In about 10% biliary colic appears to result from functional or structural abnormalities of the sphincter of Oddi.
Papillary stenosis, which is rare is fibrorotic arrowing around the sphincter ,perhaps caused by trauma and inflammation from pancreatitis,instrumentation (e.g ERCP) or prior passage of a stone.
Patients with postcholecystectomy pain should be evaluated as indicated as for extrabiliary as well as biliary cause .
If the pain suggest biliary colic,alkaline phosphatase ,bilirubin,ALT,amylase,and lipase should be measured and ERCP with biliary manometry or biliary nuclear medicine scan obtained .
Elevated liver biochemistries suggest sphincter of Oddi dysfunction, whereas elevated amylase and lipase suggest dysfunction of the sphincters pancreatic portion.
Dysfunction is best detected by biliary manometry, which shows increased pressure in the biliary tract with reproduction of the pain, although ERCP has a risk of inducing pancreatitis.
A slowed hepatic hilum-duodenal transit time on scan also suggests sphincter of Oddi dysfunction.
Diagnosis of papillary stenosis is based on ERCP.
Endoscorpic sphincterotonomy can relieve recurrent pain due to sphincter of Oddi dysfunction and especially due to papillary stenosis but is controversial for patients who have postcholecystectomy pain and objective abnormalities
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