Postcholecystectomy syndrome (pcs)

POSTCHOLECYSTECTOMY SYNDROME (PCS)

  • PCS refers to persistent abdominal pain or dyspepsia (eg, nausea) that occurs either postoperatively (early) or months to years (late) after a cholecystectomy.

  • Can be due to biliary (eg, retained common bile duct or cystic duct stone, biliary dyskinesia) or extra-biliary (eg, pancreatitis, peptic ulcer disease, coronary artery disease) causes, functional or sphincter of Oddi dysfunction

  • Patients usually notice the same pain they had prior to surgery, new pain just after surgery, or the same pain that never went away.

  • Laboratory findings can include elevated alkaline phosphatase, mildly abnormal serum aminotransferases, and dilated common bile duct on abdominal ultrasound. These findings usually suggest common bile duct stones or biliary sphincter of Oddi dysfunction (LFTs ↑ during pain and come to normal level when pain subsides).

  • The next step involves endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), or magnetic resonance cholangiopancreatography for final diagnosis and guiding therapy—detect stone-sphincter of Oddi manometry for sphincter of Oddi dysfunction (↑ pressure in this). Functional pain is diagnosis of exclusion

  • Treatment for PCS is directed at the causative factor: ERCP with sphincterotomy is the treatment of choice for sphincter dysfunction