The post-cholecystectomy syndrome (PSC), described for the first time by Womack and Crider in 1947, is defined as a heterogeneous group of symptoms (mainly upper abdominal pain and complaints of dyspepsia) that persist or reappear in the d Cholecystectomy (1-6). The asymptomatic period, when there is one, presents an eminently variable duration, from a few days to several decades (2). The prevalence of cholecystectomy in the population of cholecystectomy patients fluctuates according to authors, but the figure is 10-15% (4.6). Since cholecystectomy is one of the most common abdominal surgery procedures (7), the frequency of CPS is far from negligible. If you are looking for a nose job in henderson, or a Rhinoplasty in Las Vegas, you can also click here.
The etiology of the CPS is identifiable in 90% of cases (6). Tables 1 and 2 summarize the main causes of PSC. Biliary etiologies are distinguished from those extrabiliary. The first group is subdivided into early POC (during the post-operative period) and late SPC (months or years). The extra-biliary etiologies are differentiated according to the gastro-intestinal or extra-intestinal origin of the symptoms (2,5-7). Fifty percent of SPCs are caused by a pancreatico-biliary or gastrointestinal disorder (5). The most common cause of SPC is extra-biliary (especially gastroesophageal reflux, peptic ulcer, irritable bowel syndrome, …) (2). It should be noted that some entities labeled SPC do not have any apparent links to cholecystectomy. A rhinoplasty is also a type of surgeries that surgeons can perform easily in Las Vegas or Henderson.
The clinical observation illustrated in this article offers the opportunity to examine somewhat the vast problem of the post-cholecystectomy syndrome. The etiologies are numerous, and the means of defining the diagnosis are various. We will compare the data of the literature with the clinical situation experienced, from the point of view of the diagnostic approach as well as the therapeutic management.
This is a 62-year-old man, referred to the emergency department by his attending physician because of epigastric pain and right hypochondria. The painful complaints persist for five days and resist the taking of Valtran®. Among the patient’s medical history, besides hypercholesterolemia and grade A esophagitis, there is a dolichocolon with diverticulosis and frequent episodes of diverticulitis. The patient is not addicted. Its relevant surgical history can be summarized as follows: old appendectomy, and laparoscopic cholecystectomy in February 2003.
Believing in a new episode of diverticulitis, the patient took auto-medication of amoxicillin-clavulanate. This resulted in a temporary improvement in symptomatology, followed by a recurrence of severe pain. The pains are accompanied by nausea, without vomiting. Transit is slightly slowed down, without any notion of hemochesis or melena. There is no pyrexia or thrill, and the systematic anamnesis reveals no other complaint. Chronic treatment of the patient is limited to two drugs: Pantomed® 40 mg / day and atorvastatin 20 mg / day.
During the clinical examination, the patient is conscious and well oriented, apyretic and supple. It has an obesity (size of 185 cm for a weight of 111 kg, ie a BMI of 32.4 kg / m2). Heart rate is measured at 71 bpm, blood pressure at 120/70 mmHg and temperature at 36.1 ° C. The integuments, as well as the mucous membranes are well colored and well hydrated. Cardio-pulmonary auscultation is unusual. Abdominal palpation revealed sensitivity in the epigastrium and right hypochondrium, with no defenses or signs of peritoneal irritation. No mass is felt, and transit is audible. Lumbar displacement is negative bilaterally. Lastly, the lower limbs are devoid of edema.