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A diagnosis reconsidered: the symptomatic gallbladder remnant
Julie G Grossman1, William R Johnston1, Kathryn J Fowler2
1Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA.
Journal of Hepato-Biliary-Pancreatic Sciences
|March 2, 2019
Summary
Symptomatic gallbladder remnant after surgery is rare but treatable. Completion cholecystectomy offers definitive relief for most patients experiencing recurrent biliary symptoms post-gallbladder removal.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Diagnostic Imaging
Background:
- Gallbladder remnant disease presents a diagnostic challenge post-cholecystectomy.
- Symptomatic gallbladder remnants are infrequently characterized.
Purpose of the Study:
- To characterize the presentation, diagnosis, and treatment of symptomatic gallbladder remnants.
- To evaluate the effectiveness of various diagnostic and therapeutic modalities.
Main Methods:
- Retrospective review of 31 patients with symptomatic gallbladder remnants (2002-2016).
- Analysis of presenting symptoms, diagnostic imaging (ERCP, MRCP), and treatment outcomes.
- Comparison of surgical versus non-operative management.
Main Results:
- Right upper quadrant pain and nausea were common symptoms.
- Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) showed high sensitivity (85-90%).
- Completion cholecystectomy was definitive for 76.2% of patients; non-operative management had higher recurrence rates.
Conclusions:
- Symptomatic gallbladder remnant should be considered in post-cholecystectomy patients with recurrent biliary pain.
- Completion cholecystectomy, though challenging, is an effective treatment.
- ERCP and MRCP are valuable diagnostic tools for gallbladder remnants.
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