Presentation
Right hypochondrium pain and bloating post-laparoscopic cholecystectomy, 6 months back. Clinical examination: positive Murphy’s sign. Normal bilirubin levels.
Patient Data
Magnetic resonance cholangiopancreatogram MRCP
In the gallbladder fossa 3D MRCP image showing dilated cystic duct with a calculus and a normal appearing common biliary duct (CBD). The lesion is not connecting with the common biliary duct. There’s also pancreas divisum with multifocal small sidebranch IPMN. The duct of Wirsung is normal.
Case Discussion
Postcholecystectomy syndrome (PCS) describes the presence of symptoms after cholecystectomy. In general, postcholecystectomy syndrome arises from alterations in bile flow due to loss of the reservoir function of the gallbladder. These disorders can be classified as extra biliary and biliary. Extra biliary causes such as peptic ulcer disease, reflux esophagitis, chronic pancreatitis, mesenteric ischemia and irritable bowel syndrome.
Biliary causes include biliary stricture, biliary leakage, retained or recurrent biliary calculi, cystic duct remnant, dyskinesia of sphincter of Oddi and neuroma in the surgical bed.
Case courtesy: Dr.ssa Sara Zanzani
Radiographer: TSRM Fabio Imola
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