Post-cholecystectomy bile acid diarrhea in a teenager with sickle cell disease: Case report

Bile acid diarrhea (BAD) caused by excessive bile acids entering the colon, is a frequently overlooked cause of chronic watery diarrhea, especially in the post-cholecystectomy setting. Although increasingly recognized in adults, its occurrence in the pediatric population is rare and underreported.

We report a case of post-cholecystectomy BAD in a young female with sickle cell disease, with a history of recurrent right upper quadrant pain, gallstone disease, and re-admissions for vaso-occlusive crises who developed profuse watery diarrhea 11 days after an uneventful laparoscopic cholecystectomy. Extensive laboratory and stool investigations excluded infection, inflammation, and metabolic causes. In the absence of the ⁷⁵selenium-homotaurocholic acid (SeHCAT) test, a therapeutic trial with cholestyramine and supportive care was initiated, with marked improvement within 48 h.

This case highlights the diagnostic challenge of distinguishing bile acid diarrhea from other common postoperative causes of diarrhea such as infection, irritable bowel syndrome, or inflammatory bowel disease. In resource-limited settings, where confirmatory tests like SeHCAT or fecal bile acid measurement are unavailable, a therapeutic trial with cholestyramine offers both diagnostic and therapeutic value. Rapid symptom resolution following treatment underscores the importance of maintaining a high index of suspicion for BAD even in pediatric patients.

This case underscores the need to consider BAD as a differential diagnoses of post-cholecystectomy diarrhea, even in younger patients. Early recognition and treatment can prevent unnecessary investigations and morbidity. Greater awareness and reporting are essential to better characterize BAD in younger populations.