A diagnosis reconsidered: the symptomatic gallbladder remnant

Abstract

Background Patients can present with symptomatic gallbladder disease after cholecystectomy due to a remnant gallbladder. This is a rare problem and challenging diagnosis with limited prior characterization; thus, we present a large series of patients with a gallbladder remnant. Methods A retrospective review was performed of all patients presenting with symptomatic gallbladder remnant at a tertiary care center from 2002 to 2016. Data on presenting symptoms, diagnostic tests, treatments, and follow-up were collected. Results Thirty-one patients diagnosed and treated for a symptomatic gallbladder remnant were identified. The most common presenting symptoms included right upper quadrant pain (87%) and nausea (55%). The median time from symptom presentation to definitive diagnosis was 60 days. Diagnostic modalities utilized in the evaluation of these patients demonstrated that endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were effective with sensitivities of 85% and 90%, respectively. Twenty-three (76.2%) patients underwent completion cholecystectomy, which proved to be definitive treatment. Additionally, eight (25.8%) patients were non-operative candidates and underwent endoscopic retrograde cholangiopancreatography and sphincterotomy, three of whom developed recurrent symptoms.Conclusion A symptomatic gallbladder remnant after cholecystectomy is infrequently seen; however, the diagnosis should be considered in patients with recurrent biliary symptoms after cholecystectomy. Completion cholecystectomy can be challenging but is highly effective for definitive treatment.

Choledocholithiasis secondary to a remnant gallbladder post cholecystectomy more than 20 years ago

“…Abdominal pain in the right upper quadrant is the most common presenting complaint of patients with a symptomatic remnant gallbladder, followed by nausea and vomiting. 2 Risk factors for post-cholecystectomy choledocholithiasis (PCC) are long cystic duct stump and SC or IC. [3][4][5] A study of 362 patients who had undergone a laparoscopic cholecystectomy (LC) for benign disease had a PCC incidence of 23.5%.…”

Necrotising fasciitis of abdominal wall following rupture of reconstituted remnant gallbladder

“…It is expected to increase due to advocacy of subtotal cholecystectomy in surgical training in difficult cases (eg, frozen Calot's triangle and cirrhotic liver with varices) to prevent biliary tree injury. [1][2][3] Its symptoms mimic those of biliary colic.…”

Video Caso Clínico: Síndrome del muñón del cístico, resección laparoscópica del remanente

“…The female preponderance of gallstones is the probable reason for greater frequency of the syndrome in this gender. Clinically, the main reason for consultation is abdominal pain in the right hypochondrium and epigastrium, which occurs in 77% of the patients; accompanied by nausea, in 44% of patients; vomiting in 31% and fever in 19% of patients [5].…”

“…La preponderancia femenina de la litiasis biliar, es la probable razón de la mayor presentación del síndrome en ese género. Clínicamente, el principal motivo de consulta es el dolor abdominal en hipocondrio derecho y epigastrio, que se presenta en un 77% de pacientes; acompañado de nausea, en 44% de los pacientes; vómito en el 31% y fiebre en el 19% de pacientes [5].…”