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. 2021 Jun:83:105950.
doi: 10.1016/j.ijscr.2021.105950. Epub 2021 Apr 30.

The complications of subtotal cholecystectomy: A case report

Wafa Ben Hmida  1 , Hichem Jerraya  2 , Souhir Nasseh  2 , Nabil Haloui  2 , Mehdi Khalfallah  2 , Ramzi Nouira  2
Affiliations

The complications of subtotal cholecystectomy: A case report

Wafa Ben Hmida et al. Int J Surg Case Rep. 2021 Jun.

Abstract

Introduction: Although the symptoms attributed to gall stones resolve in most patients after cholecystectomy, some may have symptoms that persist or recur. It is known as the post-cholecystectomy syndrome (PCS). The aim of this case was to describe the diagnostic difficulties encountered and to discuss the main etiologies of this entity.

Case report: A 54-year-old man presented for a recurrent right upper quadrant pain despite laparoscopic cholecystectomy five years ago. Imaging showed cystic lesion at the gallbladder fossa with gallstones. We decided to reoperate the patient by laparoscopic approach. It turned to be a residual gallbladder with stones inside. It was confirmed by histopathology. He was asymptomatic after a follow-up of 2 years.

Discussion: The PCS should not be trivialized. Most of the causes are allocated to extra biliary etiologies. They must be ruled out first as most of them can be controlled with medication. There are etiologies for which re-operation can be necessary.

Conclusion: The indication of cholecystectomy must be taken wisely otherwise surgery will not solve the problem. Even though patient may complain of persistence or recurrence of the pain. In this case, it can be a real challenge for both diagnosis and treatment.

Keywords: Case report; Laparoscopic cholecystectomy; Post cholecystectomy syndrome algorithm; Residual gallbladder; Subtotal cholecystectomy.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The computed tomography showed a 50*25 mm fluid collection well organized at the gallbladder fossa, homogeneous and well circumscribed by a thin wall with multiple clips inside the collection (marked with arrow).
Fig. 2
Fig. 2
The magnetic resonance cholangiography revealed a 10 mm cystic lesion (marked with hollow arrow) at the gallbladder fossa with a thin wall which communicate with the common bile duct (marked with solid arrow).
Fig. 3
Fig. 3
A cystic structure of 4*2 cm size on the gallbladder fossa communicating with the common bile duct (marked with arrow).
Fig. 4
Fig. 4
Specimen of residual gallbladder with the former clip from the initial surgery (marked with solid arrow), a non-dilated cystic duct with the new clip (marked with hallow arrow).
Fig. 5
Fig. 5
Specimen of residual gallbladder with stones (marked with solid arrow) inside.
See this image and copyright information in PMC

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