Postcholecystectomy Biliary Symptoms

Patients with postcholecystectomy biliary symptoms beyond their original surgery present a diagnostic challenge for the practicing surgeon. The diagnostic algorithm is the same as in an initial episode and should rule out nonbiliary causes of right upper quadrant pain. If biliary causes are suspected, the most common diagnosis is retained common bile duct stones.(1) Among the less common diagnoses, congenital anomalies of the biliary system must also be considered. Anatomical variants are well described in medical literature and must be anticipated by the general surgeon. Here the course and imaging of 2 different patients with postcholecystectomy biliary symptoms are presented followed by a discussion of several etiologies that could cause these symptoms. These cases are presented to remind the general surgeon of the wide variety of presentations possible with biliary disease. In these situations, knowledge of a patient's surgical history can lead to confusion when attempting to make an accurate diagnosis. A prepared surgeon can help shed light on a case complicated by inconsistencies between imaging studies and patient history.