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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recurrence of pain after cholecystectomy is common. This postcholecystectomy syndrome, defined as pain that is unexplained by upper abdominal radiologic and/or endoscopic studies, including endoscopic retrograde cholangiopancreatography, often results from sphincter of Oddi dysfunction. Endoscopic demonstration of elevated sphincter of Oddi pressures is required for diagnosis. The treatment of choice is usually endoscopic sphincterotomy, which yields long-term relief in most patients. Surgical sphincteroplasty or use of calcium channel blockers or long-acting nitrates may be effective if endoscopic sphincterotomy is not suitable.
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PMID:Postcholecystectomy syndrome. How to determine if the sphincter of Oddi is the cause. 154 15

The study evaluates the effect of 20 mg cisapride twice daily on symptoms and biliary drainage in patients with the postcholecystectomy syndrome. Nineteen patients, all female, went through a randomized, double-blind, placebo-controlled, crossover trial with two 4-week treatment periods separated by a 2-week washout period. Symptoms were registered on diary cards. Biliary drainage was studied with dynamic cholescintigraphy. The down slope of the time-activity curve (T1/2 and elimination index) was used as a measure of the biliary drainage. More symptoms were registered during cisapride therapy than with placebo. This unfavourable effect of cisapride was statistically significant in a subgroup of patients with postcholecystectomy complaints identical to the biliary pain they experienced during injection of contrast at the endoscopic retrograde cholangiopancreatographic examination. Cisapride statistically significantly hastened biliary drainage. The median T1/2 values were 24 and 28 min after cisapride and placebo, respectively (p less than 0.01). In conclusion, cisapride promoted biliary drainage in patients with the postcholecystectomy syndrome but had an unfavourable symptomatic effect in those with bile duct-triggered postcholecystectomy complaints.
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PMID:Effect of cisapride on symptoms and biliary drainage in patients with postcholecystectomy syndrome. 194 87

To assess the possibility of common bile duct distensibility after cholecystectomy, we made a retrospective study of patients who had ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). The study comprised 52 patients without extrahepatic biliary obstruction; 19 had had cholecystectomy, 18 of whom complained of biliary colic similar to that they had had originally. The other 33 patients had intact, well visualized gallbladders; 15 of these patients had pain in the right upper quadrant or epigastrium, but none had chronic pancreatitis. The average diameter of the common bile duct at its widest point by ultrasonography was 4.8 mm (range, 4.0 to 9.0 mm) in the 33 patients with intact gallbladders, and 5.7 mm (range, 4.0 to 8.0 mm) in the 19 patients who had had cholecystectomy. The diameter by ERCP was 4.4 mm (range, 2.9 to 6.3 mm) in the patients with intact gallbladders, and 11.17 mm (range, 6.9 to 14.7 mm) in the patients who had had cholecystectomy. In each patient who had had cholecystectomy the diameter as measured by ERCP was larger than it appeared by ultrasonography. The results suggest that the common bile duct is distensible, and that this distensibility may be related to the postcholecystectomy syndrome.
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PMID:Common bile duct distensibility after cholecystectomy. 205 59

Experimental reports have proved that bile acids damage the gastric mucosa. Moreover it is now accepted that duodenogastric reflux occurs in 20-30% of cholecystectomized persons. The Authors, with the purpose of defining a correlation between gastric mucosa damage by duodeno-gastric reflux and postcholecystectomy syndrome have taken into consideration two groups of 14 patients each. To the first group belonged cholecystectomized patients, who had episodic, often postprandial pain, constant heart burn, with associated vomiting and Hypochromic anemia. To the second group belonged asymptomatic patients with previous cholecystectomy. All these patients were endoscoped (EGDS), and their endoscopic biopsy specimens were surveyed. 99Tc HIDA cholescintigraphy was performed in all the groups of patients, after endoscopy. In 85% of symptomatic patients we found, during endoscopy, reflux of bile into the stomach with associated reddish and inflammatory change of antral mucosa vs. 7.14% of the control group. Atrophic chronic gastritis was found in 71.43% of endoscopic biopsy specimens of Symptomatic vs. 14.28% of asymptomatic patients. Superficial chronic gastritis was found in 28.57% of symptomatic vs. 50% of asymptomatic patients. At last we found active atrophic or superficial antral gastritis (Whitehead) in 90% of symptomatic patients vs. 0% of asymptomatic people. The Authors conclude that there is a positive correlation between duodenogastric reflux and postcholecystectomy syndrome when biliary reflux is correlated with an histological finding of antral active chronic gastritis.
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PMID:[Correlation between post-cholecystectomy syndrome and biliary reflux gastritis. Endoscopic study]. 269 12

Sixty-five non-icteric patients presumed to have the postcholecystectomy syndrome (PCS) were followed up for 4-13 years after their first endoscopic retrograde cholangiopancreatography (ERCP) examination, which gave normal findings. All patients, however, experienced severe pain on injection of only 1-2 ml of contrast medium over 5-10 sec into the common bile duct (CBD). Thirty-four of the 65 patients were found to have true PCS on long-term follow-up studies, whereas 31 of them had other diseases. A second ERCP also showed normal results, and the injection-related pain was preceded by an abnormal pressure rise in the CBD at manometry. The CBD acted like a pain trigger zone, and the pain reaction might be diagnostic in everyday clinical practice. In conclusion, ultrasonography is an adequate diagnostic method in non-obstructive PCS. Medical treatment is often successful. ERCP and interventional treatment should be reserved for patients with obstructive symptoms and for patients in whom all medical treatment has failed.
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PMID:The postcholecystectomy syndrome: bile ducts as pain trigger zone. 338 90

Endoscopic retrograde cholangiopancreatography (ERCP) has become an essential tool to investigate patients with the postcholecystectomy syndrome. A normal cholangiogram usually rules out the presence of biliary tract disease, and further investigations are directed towards other organ systems. We present a case in which a normal ERCP caused a significant delay in reassessing the biliary tree in a patient who eventually presented with choledocholithiasis. A repeat ERCP should be considered in patients with persistent biliary tract pain, even if the initial ERCP shows no abnormality.
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PMID:Misdiagnosis using endoscopic retrograde cholangiopancreatography in a patient with postcholecystectomy pain. 350 72

A 66-year old woman had had intermittent anterior chest pain and upper abdominal pain for 15 years. Angina pectoris was diagnosed at the age of 51 years, as she had typical anginal pain that was relieved by nitroglycerine, although coronary arteriography was normal and the ergonovine provocative test was negative. She had undergone cholecystectomy at the age of 38 years. Her bile duct pressure increased markedly after morphine injection and severe pain with the aforementioned distribution was produced. Postcholecystectomy syndrome due to sphincter of Oddi spasm was diagnosed and her pain was relieved by endoscopic sphincterotomy.
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PMID:Postcholecystectomy syndrome mimicking angina pectoris detected by the morphine provocation test. 771 81

The symptoms of 100 patients with gall bladder stone disease were prospectively analysed before and after successful treatment with extracorporeal shock wave lithotripsy (ESWL) and oral bile acids. This is of considerable clinical interest because complaints after cholecystectomy persist in 21-47% of patients (postcholecystectomy syndrome). Before ESWL, 37 patients had unspecific abdominal symptoms (feeling of fullness and pressure, or slight pain, or both, in the right upper abdomen, flatulence, nausea, or food intolerance) and 63 patients had typical biliary symptoms (severe steady pain of more than 15 minutes and less than five hours duration in the right upper abdomen, in some cases radiating to the epigastrium or the back) either exclusively or with unspecific abdominal complaints. After becoming stone free, 72 of 100 patients lost the symptoms they had before treatment. All 28 patients with persisting symptoms had unspecific abdominal symptoms before treatment (exclusively unspecific symptoms and unspecific plus typical biliary symptoms). In contrast, patients with typical biliary symptoms before ESWL lost these in 95% of all cases. Although the anatomical structures are left intact after ESWL, the percentages of stone free patients with persisting symptoms are similar to those after cholecystectomy.
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PMID:Relief of heterogeneous symptoms after successful gall bladder stone lithotripsy and complete stone disappearance. 802 Aug 12

A 42-year-old man presented with acute right upper quadrant abdominal pain 2 years after open cholecystectomy. Evaluation revealed cholecystitis in a second gallbladder and a second cholecystectomy was performed. Acute right upper quadrant abdominal pain after cholecystectomy presents a wide differential diagnosis, including the often idiopathic and difficult to manage postcholecystectomy syndrome. Emergency physicians should be aware of the most common causes of pain in these patients. Previously unrecognized congenital abnormalities of the biliary system should be considered when the diagnosis is not clear, as highlighted by this case report.
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PMID:Duplicate gallbladder cholecystitis after open cholecystectomy. 1021 37

Post-cholecystectomy syndrome refers to a wide spectrum of conditions that pose a challenging diagnostic dilemma. Cystic duct remnant, defined as a residual duct greater than 1 cm in length, may, in the presence of stones, cause post-cholecystectomy syndrome. In this report, 4 patients with post-cholecystectomy syndrome due to cystic duct remnant are described. All underwent laparoscopic cholecystectomy and one was converted to open. The patients presented with pain 10 months to 9 years post-cholecystectomy and investigations demonstrated cystic duct remnant. All patients underwent successful resection with resolution of symptoms. In this era of laparoscopic surgery, where surgery favors a long cystic duct remnant, we should be aware of cystic duct stones as a possible cause of postcholecystectomy syndrome. This report highlights magnetic resonance cholangiopancreatography as the optimal method for evaluating the biliary tract in these cases.
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PMID:Cystic duct remnant and the 'post-cholecystectomy syndrome'. 1501 27


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