Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome

Intestinal adhesions after cholecystectomy are a possible cause of abdominal complaints. In this prospective autopsy study, we examined the frequency of intestinal adhesions in 100 consecutive patients who had had a cholecystectomy at some stage in their medical history. In addition, we retrospectively surveyed the patients' files in order to clarify the presence of significant postoperative abdominal complaints indicated by recordings of relaparotomy or gastrointestinal examinations in hospital after the initial cholecystectomy. We found that 9 (9%) of the patients had severe intestinal adhesions (small bowel or caecum tightly fixed to the bed of the gallbladder, forming a kink) at autopsy. Relaparotomy had been performed on 4 (4%) patients. Thirty-four (34%) patients had had significant abdominal complaints. The presence of these adhesions, particularly of distal ileum (6 patients), significantly (p = 0.005) accumulated in patients with recordings of postoperative complaints. The tumours, or tumour-like scars, in the cystic duct-stump and choledochal region found in 15 (15%) patients also independently correlated (p = 0.04) with the postoperative abdominal complaints. Other autopsy findings, such as peptic ulcers, cystic remnants, or choledochal stones showed no association with the complaints. We conclude that intestinal adhesions and scars in the choledochal region are clinically significant and relatively common causes of abdominal complaints after cholecystectomy, and that they should be considered after other causes, e.g. those of biliary origin, have been excluded.