Has anybody experienced, or noticed that most patients after about 12 months after Cholecystectomy present, frequently watery diarrhea, skin rash with allergy, bone or articulation pains without trauma and unspecific anxiety, apart from other relative laboratory analysis like Cholesterol, Liver enzymes etc.
The following paper by Jaunoo et al (2009) explored the Postcholecystectomy syndrome and its main aetiological theories which may be helpful in your search for further information?
S.S. Jaunoo, , S. Mohandas, and L.M. Almond Postcholecystectomy syndrome (PCS). International Journal of Surgery. 8(1): 15–17.DOI: 10.1016/j.ijsu.2009.10.008. http://www.sciencedirect.com/science/article/pii/S1743919109001538
Since 2001 we treated 98 patients under 17 years old with cholecystectomy. Only two had diarrhea by a few months.
Rashid,
After more than 1000 cholecystectomies I couldn't support your observations. It's not the most patients and it's not majority and not even minor group. Diarrhoea we've seen very very seldom (like Sergio), don't remember any rash ...
Dear Rasheed,
My experience is identical to Jan's, both concerning number of personal cholecystectomies, and the incidence of diarrhea.
Post-cholecystectomy diarrhea is often caused by chronic leakage of gall juice to the duodenum, even when not triggered by the ingestion of fat food. If the surgical indication is appropriate, the risk should be low for this to occur, and especially to last for a longer period of time.
You never see this diarrhea after removal of a chronic cholecystitis. Might it be that the gall storage and transport system in those cases has already adapted to function without the bladder? My personal clinical impression is that the risk might be higher if the surgeon has removed a normally functioning gallbladder, in spite that it happened to contain (asymptomatic, which sometimes may be difficult to determine preoperatively) stones,
Dear Jan & Bengt,
Perhaps the following articles and facts below could assist your doubts about the new observation of probable syndrome and side effects of the procedure;
It should be remembered that cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal.
The cholecystosphincter of Oddi reflex,(1) cholecysto-antral reflex,(2) and cholecysto-oesophageal reflexes.(3) are all disrupted and a number
of local upper gastrointestinal hormonal changes also occur after
cholecystectomy.(4) Thus, there is an increased incidence of
gastritis, alkaline duodenogastric reflux and gastro-oesophageal
reflux after cholecystectomy, all of which may be the basis for
postcholecystectomy symptoms.
(1)- Muller EC, Lewinski MA, Pitt HA. The cholecystosphincter of Oddi reflex. J Surg
Res 1984;36:377–83
(2)- Webb TH, Lillemoe KD, Pitt HA. Gastrosphincter of Oddi reflex. Am J Surg
1988;155:193–8.
(3)- Stuart R, Byrne PJ, Marks P, Lawlor P, Gorey TF, Hennessey TPJ. Extrinsic
pathology alters oesophageal motility in the dog. Br J Surg 1990;77:A709.
(4)- Adrian TE, Savage AP, Bacarase-Hamilton AJ, Wolfe K, Besterman HS, Bloom SR. Peptide YY abnormalities in gastrointestinal disease. Gastroenterology
1986;90:379–84.
Dear Rasheed,
I don't see why either duodeno-gastric or gastro-esophageal gall reflux (well-known consequences after cholecystectomy) would cause diarrhea, skin rash and bone/articulate pain.
Dear Rasheed,I mentioned in one of our previous discussions we have large numbers
but we do see diarrhoea and dyspeptic symptoms but I have not come across other symptoms and signs mentioned.Interesting to note the physiological theories mentioned.
Sorry to butt in....critically thinking, i ventrued into google search looking for central parasympathetic / sympathetic causes from the CENTRAL NERVOUS SYSTEM (for example hypothalamus) to explain generalised rash, But this was first in my list of responses:
http://www.dermnetnz.org/doctors/principles/symptoms.html
Vancomycin red man syndrome was my second thought.
Dear Brengt, factors like mal-absorption and supposed increase in bacterial degradation after the removal of gallbladder function could cause diarrhea and I constantly apply oral anti-parasite medication each recurrent syndrome which occurs at most every semester.
Postcholecystectomy syndrome I think is the persistent of the initial symptoms of GBS specially dyspepsia. rather than diarrhea and skin rash . so it need to be labeled differently.
Important to distinguish between persistent symptoms after lap cholecystectomy i.e. the diagnosis may have been wrong in the first place (or more than one pathology causing symptoms synchronously) and new symptoms that emerge following surgery.
Following cholecystectomy conditions such as small bowel bacterial overgrowth, bile salt malabsorption / dysfunction / diarrhoea are more common. I also consent all IBS sufferers with gallstones that their IBS type symptoms may be worse after surgery.
Post cholecystectomy Syndrome seems to encompass all of these conditions even though they are very different in aetiology and management
Skin rash and bone / articulate pain could be hypotheticaly related to auto-imune consequence, to excess bacterial degradation concentration, due to insuficient physiological excretion means even by cutaneal factors (specific hypersensibility )and bone synovial membrane fluid (Synovitis) .
