The postcholecystectomy syndrome: bile ducts as pain trigger zone.
Sixty-five non-icteric patients presumed to have the postcholecystectomy syndrome (PCS) were followed up for 4-13 years after their first endoscopic retrograde cholangiopancreatography (ERCP) examination, which gave normal findings. All patients, however, experienced severe pain on injection of only 1-2 ml of contrast medium over 5-10 sec into the common bile duct (CBD). Thirty-four of the 65 patients were found to have true PCS on long-term follow-up studies, whereas 31 of them had other diseases. A second ERCP also showed normal results, and the injection-related pain was preceded by an abnormal pressure rise in the CBD at manometry. The CBD acted like a pain trigger zone, and the pain reaction might be diagnostic in everyday clinical practice. In conclusion, ultrasonography is an adequate diagnostic method in non-obstructive PCS. Medical treatment is often successful. ERCP and interventional treatment should be reserved for patients with obstructive symptoms and for patients in whom all medical treatment has failed.
Lasson
A
A
Dept. of Surgery, Malmö General Hospital, University of Lund, Sweden.
Fork
F T
FT
Trägårdh
B
B
Zederfeldt
B
B
D001657:Biliary Dyskinesia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D013577:Syndrome