It is generally conceded that after cholecystectomy performed for cholelithiasis moderate to severe postoperative symptoms occur in from 10 to 25% of patients.1 When cholecystectomy is performed for the so-called noncalculous gallbladder, symptoms persist in about 50% of the patients.2 The possible causes for persistent or recurrent symptoms are many. They include calculi in the hepatic, common, or cystic ducts; stone or inflammation of the gallbladder stump; common duct stricture; residual cholangitis, hepatitis, and pancreatitis; neuromas about the common duct; postoperative adhesions; biliary dyskinesia; and, not infrequently, erroneous preoperative diagnoses or associated diseases, such as hiatal hernia, unrecognized malignant lesion, gastric or duodenal ulcer, arthritis of the spine, or psychoneurosis. These patients present a real challenge to the clinician.
Sandweiss DJ, Fulton H. INTRAVENOUS CHOLANGIOGRAPHY: RESULTS IN ONE HUNDRED CHOLECYSTECTOMIZED PATIENTS WITH UPPER ABDOMINAL SYMPTOMS. JAMA. 1955;159(10):998–1001. doi:10.1001/jama.1955.02960270018005
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