Abstract
Introduction:
Gallbladder remnant cholecystitis is a known complication of subtotal cholecystectomy, particularly after operative intervention for acute calculous disease. Postcholecystectomy syndrome may occur secondary to the gallbladder remnant or a long cystic duct. Symptoms include right upper quadrant pain and dyspepsia. Other etiologies include inflammation from scarring, surgical bed neuromas, biliary strictures, sphincter of Oddi dysfunction, recurrent calculi, granulomas, or choledochocele. The most common cause of this process is failure to identify the cystic duct that can occur in acute inflammation. Diagnostic imaging includes ultrasonography and computed tomography (CT) to identify the etiology in ∼50% of cases. Diagnostically, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography are more specific and sensitive. 1 A completion cholecystectomy is recommended to resolve symptoms. This video presents a case of a remnant gallbladder that requires excision.
Materials and Methods:
A 43-year-old man with acute gangrenous cholecystitis underwent a laparoscopic cholecystectomy. Three months later he presented with epigastric pain for 3 days duration. The patient underwent an ultrasonography that demonstrated a 3-cm calculous cystic duct remnant with a nondilated 6 mm proximal common bile duct. An esophagogastroduodenoscopy was performed with Helicobacter pylori biopsy that was negative. A CT scan with intravenous contrast was obtained that showed a cystic duct as well as a gallbladder stump containing a small calculous. An MRCP confirmed findings of the gallbladder remnant containing a stone. The patient was taken to the operating room and underwent a completion cholecystectomy with an intraoperative cholangiogram using the prior cholecystectomy incisions. Total operative time was 120 minutes.
Results:
The patient had an uneventful postoperative course and was discharged home on postoperative day 1. He was doing well at his hospital follow-up visit. He was completely asymptomatic and had returned to work 1 week after surgery.
Conclusion:
Recurrent cholecystitis after a cholecystectomy is an uncommon event in the western hemisphere. Diagnostically, an MRCP is highly accurate in delineating a gallbladder remnant or intra- or extrahepatic biliary disease. If a gallbladder remnant with intraluminal calculi is ascertained, the remnant should be removed.Additional resources used in the research of this video are Calhoun, 2 Chatra, 3 Girometti et al., 4 Grossman et al., 5 Gupta et al., 6 and Kar et al. 7
No competing financial interests exist.
Runtime of video: 6 mins 33 secs
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