Cystic Duct Stump Calculus Mimicking Functional Dyspepsia: A Rare Cause of Post-cholecystectomy Syndrome

Abstract

Persistent gastrointestinal symptoms after cholecystectomy are not uncommon and are frequently attributed to functional disorders such as dyspepsia or gastritis. However, rare structural causes (such as retained calculi within the cystic duct stump or a remnant gallbladder) can mimic benign gastrointestinal conditions, particularly in the absence of classical biliary signs. We present the case of a 47-year-old female with a one-year history of postprandial epigastric discomfort, bloating, and dyspepsia. She had undergone an open cholecystectomy five years earlier for gallstone disease. Despite multiple courses of proton pump inhibitors and a normal upper gastrointestinal endoscopy, her symptoms persisted. Laboratory studies revealed mildly elevated alanine transaminase (ALT) (64 U/L), while other parameters, including complete blood count and Helicobacter pylori stool antigen, were normal. Abdominal ultrasound identified a 1.2 cm calculus within the cystic duct stump. Given the persistent symptoms and imaging findings, the patient underwent elective exploratory laparotomy, which confirmed the presence of dense adhesions and a retained stone. Completion cholecystectomy using a fundus-first approach was performed successfully, and the patient experienced complete symptom resolution postoperatively. This case highlights the importance of maintaining a high index of suspicion for retained biliary calculi in patients with persistent upper abdominal symptoms following cholecystectomy, especially when standard investigations such as endoscopy fail to identify a cause. A systematic diagnostic approach that includes targeted biliary imaging is essential to avoid misdiagnosis, reduce unnecessary treatments, and ensure timely surgical intervention when indicated.

Keywords: case report; completion cholecystectomy; cystic duct stump stone; functional dyspepsia mimic; post-cholecystectomy syndrome.

Figure 1. Shrunken gall bladder remnant and excised cystic duct stump containing retained stone

The excised cystic duct stump contained a retained calculus. The specimen was obtained during the completion cholecystectomy performed to resolve persistent dyspeptic symptoms following the previous cholecystectomy.