Praneetha Narahari, MD. Saint Agnes Medical Center, Fresno, CA.
Advances in laparoscopy have expanded its use from cholelithiais to acute cholecystitis. Partial or subtotal cholecystectomy is acceptable in the presence of dense inflamation in the calot’s triangle. It has been reported as safe and without consequences. With increasing volume it has been noted that gallbladder remnant can cause ongoing pain and jaundice and there are case reports of successful laparoscopic removal. I report a case of symptomatic gallbladder remnant treated with laparoscopic cholecystectomy and cholangiogram.
35 yr old obese female presented with biliary colic, epigastric and girdle like pain worse with eating, had lap chole about 7 yrs earlier. Multiple ER visits for this pain. MRI suggestive of GB remnant with stones and an earlier CT with calcification in GB fossa with elevated AST/ALT of 234/498. Operative findings include a 3 cm GB remnant with normal IOC. There was a caterpillar hump of right hepatic artery, suggesting that the gallbladder remnant may have been left behind due to the proximity to the right hepatic artery.
Biliary cause of pain should be considered when patients present with post cholecystectomy pain. Gallbladder remnant can be identified by radiologic tests. Cholangiogram may obviate the need for a second invasive procedure such as diagnostic ERCP when liver enzymes are elevated. Gallbladder remnant is a real entity and can be safely removed with laparoscopy.
1. Cholangiogram 2. GB fossa with porta 3. Remnant adjacent to Right hepatic artery 4. Gallbladder specimen 5. Pre op MRI/MRCP showing the remnant in GB fossa 6. Pre op CT scan with calcs in the GB fossa