Recurrent attacks of upper right quadrant pain after cholecystectomy are not infrequent.
In most of these cases, the cause of the pain remains undiagnosed. Insufficient cholecystectomy
has been described as a rare cause of post-cholecystectomy pain, although the true
incidence is unknown. It is difficult to diagnose a residual gallbladder or a large
cystic duct with residual stones, due to the size of the remaining structures. This
report presents three patients who had experienced a long period of agonizing biliary-type
pain after cholecystectomy. Abdominal ultrasound examinations, and magnetic resonance
cholangiopancreatography (MRCP) in one patient, were normal. Endoscopic ultrasonography
(EUS) demonstrated the presence of a small cystic structure with echogenic foci compatible
with a residual gallbladder containing small gallstones. Two of the three diagnoses
were confirmed by repeat surgery. EUS thus appears to be a valuable method for diagnosing
insufficient cholecystectomy, and should be considered in patients with persistent
pain attacks after cholecystectomy.
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H. Hassan, M. D.
Rødovrevej 200, 2. TH · 2610 Rødovre · Denmark
Email: hazim@dadlnet.dk
