Symptomatic Cholelithiasis of a Remnant Gallbladder after Open Cholecystectomy

Recurrent abdominal pain, particularly in the right upper quadrant (RUQ) in a patient with a history of cholecystectomy, known as postcholecystectomy syndrome, requires a broad differential diagnosis. Pathology of a retained gallbladder remnant is an exceedingly rare etiology of this pain.

A 49-year-old woman who had previously undergone an open cholecystectomy presented to the emergency department with several hours of postprandial RUQ pain and emesis. Liver function tests and lipase were not significantly elevated. RUQ ultrasonography revealed a cystic structure containing a stone with mild prominence of the common bile duct at 7 mm, and magnetic resonance cholangiopancreatography confirmed the presence of a remnant gallbladder without common bile duct obstruction. Her pain subsided, she tolerated a diet, and was discharged with a referral for an elective cholecystectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abdominal pain is the most common chief complaint of patients presenting to the emergency department in the United States, and emergency physicians routinely encounter patients with postcholecystectomy syndrome. Emergency physicians should not exclude the possibility of remnant gallbladder pathology, such as symptomatic cholelithiasis or cholecystitis, in patients presenting with symptoms concerning for biliary colic, even if the patient has undergone previous cholecystectomy.