PROBLEMS AFTER GALL BLADDER REMOVAL

PROBLEMS AFTER GALL BLADDER REMOVAL

Introduction


The gall bladder removal is done by operation called cholecystectomy which either done by open surgery (open choelcystecomy ) or by laparoscopy (laparoscopic cholecystectomy

 This operation is very common all over the world which done mainly for stones in the gall bladder and most of the patients are recovered postoperative without any complications

 There are many problems can be associated with removal of the gall bladder but these problems are very rare to occurs

These problems ( postcholecystecomy problems ) can be divided into either early problems which occurs sooner or days after the operation or late problems months or years or postcholecystectomy syndrome

Early postcholecysteomy problems

Normally the patient after cholecystectomy operation stay in hospital one or two days then go to home and recovered with full activities within 10 days any deviation from this course should be raise the concerns about the possibility of a complications and the causes are evaluated by the surgeon
these complications may be
  • The patient may complaining from persistent abdominal pain bloating abdominal distension
  • Anorexia,vomiting
  • Pain and jaundice
These problems if happened should be investigated seriously because that mean there is a problem with this operation such as
  • Bile leakage which appear in the intrabdominal catheter drain as yellowish or biliary fluid this catheter drainage is left in the patients abdomen to drainage any fluid residual after the operations that means either there is biliary tract injuries or slipped cystic duct stump
  • This bile leakage also can come from the liver bed from intracanalcuilar biliary ducts which can not seen by the eyes that type of biliary leakage can be stopped alone without any interference if the catheter drain still present inside the abdomen
  •  Intraperitoneal fluid collection in the form of bile ascites when bile leakage spread in the whole abdomen or become localized in the site of operation gall bladder or liver bed called( bilioma
  • Hemoperitoneum due to bleeding from vascular injuries or slipped ligature of the cystic artery which is the only artery ligated during cholecystectomy operations or injury to other vessels like to hepatic artery rare to portal vein because this type of injury seen easy during the operation
  • Common bile duct or hepatic duct obstructions which may occurs either due to wrong ligation by suture or clipped  instead of ligation of the cystic duct or due to missed stone in the common bile duct the patient come with picture of obstructive jaundice as yellowish discolouration of the skin and sclera of the eyes the colour of his urine become dark red like tea and the stool colour become pale or calley and fever due to inability of the bile salts to reach the intestine due to this obstruction
  • Biliary-cutaneous fistula may occurs also
  • Retained bile inside the abdomen without drainage can causes major problems because bile very irritant and causes peritonitis which lead to sepsis and infections and can causes multi-organs failure if not treated rapid
  • Injury to the abdominal viscera like colon duodenum or stomach or others organs but these injuries can be seen during the operation and can be deal with it but if not discovered the patient come also with a picture of peritonitis with severe abdominal pain abdominal distension fever vomiting  injury to the colon causes feacal peritonitis due to the presence of the feaces inside the abdomen injury to the duodenum causes also biliary peritonitis
  • Other complications like any operation like wound infection seroma or heamatoma of the wounds
Late postcholecystectomy problems
Late complications of cholecystectomy may range from mild gastrointestianl tract (GIT) complains to severe incapacitating pain such as
  •  Patients common complains from indigestion bloating flatulence and diarrhea
  • Patients whom complaining from abdominal pain fever and jaundice after long postoperative symptoms free period should be suspected recurrent common bile duct stones
  • Other late complications may occur such as bile duct stricture  biliary fistula retained stones in common bile duct or in cystic duct pancreatitis and infection
  • It should be consider that these symptoms may due to other causes such as pancreatic cancer peptic ulcer gastric cancer renal disease reflux esophagitis and coronary artery disease irritable bowel syndrome cholangiocarcinoma sclerosing cholangitis stenossing papillitis and wound neuroma these need careful examination and investigations
Postcholecystectomy syndrome
 These syndrome can appear after cholecytectomy operation in the form of the presence of symptoms of gall bladder stone where the exact causes unclear which
  •  Some patients may continue to have symptoms like abdominal colic pain diarrhea vomiting nausea and bloating after cholecystectomy and after careful and repeated investigations of these patients there is no evidence of cancer stones strictures ulcers can be found
  • There are two diseases may can explained this syndrome which are biliary dyskinesia and papillary stenosis
  • Biliary dyskinesia  refers to motility disorders and papillary stenosis refers to  structural abnormailties
  • Biliary dyskinesia it is motor abnormailities of the sphincter of Oddi and may produce disturbances of the biliary function and give symptoms such as unexplained biliary pain
  • Papillary stenosis it may causes recurrent biliary pain after cholecystectomy may also causes recurrent pancreatitis that stenosis may due to papillary fibrosis from intermittent passage of stones other causes may include instrumentation intubation Ascariasis worms cholesterolsis peptic ulcer and pancreatitis the patient may complaining from that pain after 5 years from postcholecystectomy 
  • The pain of papillary stenosis is episodic severe and located in the epigastric or right upper quadrant region of the abdomen  the pain can occur at any time  not related to meals typically the pain lasts for 12-36 hours and the relieved may need for narcotic to relief the pain during the attack
  • Other causes of postcholecystectomy syndrome are may due to technical errors as leaving long or very short stump of cystic duct but nowadays these may be not important as in laparosopic cholecystectomy long cystic duct remnant are left without complaining
These patients need for careful examination and investigations as follow see here

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1 comment:

Prachi Kulkarni said...

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