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Journal of Gastrointestinal Surgery

, Volume 18, Issue 7, pp 1278–1283 | Cite as

Surgical and Endoscopic Management of Remnant Cystic Duct Lithiasis After Cholecystectomy—a Case Series

  • Michael R. PhillipsEmail author
  • Mark Joseph
  • Evan S. Dellon
  • Ian Grimm
  • Timothy M. Farrell
  • Christopher C. Rupp
Original Article

Abstract

Introduction

Postcholecystectomy syndrome (PCS) as a result of remnant cystic duct lithiasis (RCDL), or gallstones within the cystic duct after cholecystectomy, can cause persistent or recurrent symptoms after cholecystectomy.

Study Design

A retrospective descriptive analysis was performed for all patients with RDCL at a single institution between 2001 and 2012. Details of presentation, diagnosis, and surgical and endoscopic treatments, and outcomes were collected and analyzed.

Results

Twelve patients with RCDL were identified. The interval between cholecystectomy to RCDL discovery was 34.2 months (range 0.5–168 months). On a standard liver enzyme panel, 75 % of patients had derangements in ≥1 indices, with the most common single laboratory test abnormality occurring in gamma-glutamyl transferase (GGT) (80 %). Eight operative reports noted that the cystic duct was noticeably dilated at the time of cholecystectomy. Two patients developed a cystic duct leak (Strasberg type A bile duct injury) postoperatively, which was managed nonoperatively. Six cases of RCDL required surgery, and six were managed endoscopically.

Conclusion

RCDL is a potential cause of postcholecystectomy syndrome, but the true incidence is unknown. Laboratory analysis and imaging are helpful in establishing the diagnosis of RCDL. Endoscopic therapy has a role in the treatment of RCDL, but surgical excision of the remnant cystic duct lithiasis may be required.

Keywords

Remnant cystic duct lithiasis (RCDL) Cholecystectomy Postcholecystectomy syndrome 

Abbreviations

RCDL

Remnant cystic duct lithiasis

GGT

Gamma-glutamyl transferase

PCS

Postcholecystectomy syndrome

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

Notes

Conflict of Interest

All authors declare that they have no conflicts of interest. This paper has not been published previously.

Funding

Institutional support was provided by the Department of Surgery at the University of North Carolina at Chapel Hill. There are no relevant financial disclosures.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Michael R. Phillips
    • 1
    Email author
  • Mark Joseph
    • 1
  • Evan S. Dellon
    • 2
  • Ian Grimm
    • 2
  • Timothy M. Farrell
    • 1
  • Christopher C. Rupp
    • 3
  1. 1.Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of SurgeryPrevea HealthGreen BayUSA

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