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a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/15 00:03:24」(JST)

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Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy).

Symptoms of postcholecystectomy syndrome may include:

Upset stomach, nausea, and vomiting.
Gas, bloating, and diarrhea.
Persistent pain in the upper right abdomen.^[1]

Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,^[2] and can be transient, persistent or lifelong.^[3]^[4]

The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions.^[5] A recent study^[6] shows that postcholecystectomy syndrome can be caused by biliary microlithiasis.

Approximately 50% of cases are due to biliary causes such as remaining stone, biliary injury, dysmotility, and choledococyst. The remaining 50% are due to non-biliary causes. This is because upper abdominal pain and gallstones are both common but are not always related.

Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3).^[4] This can be treated with a bile acid sequestrant like cholestyramine^[7]^[3] or colesevelam,^[8]^[9] which may be better tolerated.^[10]

Diagnostics

Ultrasound of the abdominal cavity.
General and biochemical blood.
Intravenous cholangiography.
Esophagogastroduodenoscopy for examination of the stomach, duodenum and the area major duodenal papilla.
Retrograde cholangiopancreatography.
Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)

Helen Shishiveni Treatment

Some individuals may benefit from diet modification, such as a reduced fat diet, following cholecystectomy. The liver produces bile and the gallbladder acts as reservoir. From the gallbladder, bile enters the intestine in individual portions. In the absence of gallbladder, bile enters the intestine constantly, but in small quantities. Thus, it may be insufficient for digestion of fatty foods. Postcholecystectomy syndrome treatment depends on the identified violations that led to it. Typically, the patient is recommended dietary restriction table with fatty foods, enzyme preparations, antispasmodics, sometimes cholagogue.^[11]

If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.^[6]

References

^ Womack NA, Crider RL (1947). "The Persistence of Symptoms Following Cholecystectomy". Ann. Surg. 126 (1): 31–55. doi:10.1097/00000658-194707000-00004. PMC 1803303. PMID 17858976.
^ "Postcholecystectomy syndrome". WebMD. Retrieved 2009-03-07.
^ ^a ^b Danley T, St Anna L (October 2011). "Clinical inquiry. Postcholecystectomy diarrhea: what relieves it?". The Journal of Family Practice 60 (10): 632c–d. PMID 21977493.
^ ^a ^b Sciarretta G, Furno A, Mazzoni M, Malaguti P (December 1992). "Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test". The American Journal of Gastroenterology 87 (12): 1852–4. PMID 1449156.
^ Hyvärinen H, Sipponen P, Silvennoinen E (December 1990). "Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome". Hepatogastroenterology 37 (Suppl 2): 58–61. PMID 2083937.
^ ^a ^b Okoro N, Patel A, Goldstein M, Narahari N, Cai Q (July 2008). "Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis". Gastrointestinal Endoscopy 68 (1): 69–74. doi:10.1016/j.gie.2007.09.046. PMID 18577477.
^ Farahmandfar, Mohammad Reza (2012). "Post Cholecystectomy Diarrhoea—A Systematic Review". Surgical Science 3 (6): 332–8. doi:10.4236/ss.2012.36065.
^ Odunsi-Shiyanbade ST, Camilleri M, McKinzie S et al. (February 2010). "Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function". Clinical Gastroenterology and Hepatology 8 (2): 159–65. doi:10.1016/j.cgh.2009.10.020. PMC 2822105. PMID 19879973.
^ Zema MJ (2012). "Colesevelam hydrochloride: evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action". Core Evidence 7: 61–75. doi:10.2147/CE.S26725. PMC 3426253. PMID 22936894.
^ Puleston J, Morgan H, Andreyev J (March 2005). "New treatment for bile salt malabsorption". Gut 54 (3): 441–2. doi:10.1136/gut.2004.054486. PMC 1774391. PMID 15711000.
^ http://medusanews.com/diseases-and-conditions/gastroenterology/postcholecystectomy-syndrome.html^{[full citation needed]}

UpToDate Contents

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1. 腹腔鏡下胆嚢摘出術の合併症 complications of laparoscopic cholecystectomy
2. 腹腔鏡下胆嚢摘出術 laparoscopic cholecystectomy
3. オッディ括約筋機能不全の臨床症状よび診断 clinical manifestations and diagnosis of sphincter of oddi dysfunction
4. オッディ括約筋機能不全の治療 treatment of sphincter of oddi dysfunction
5. 総胆管結石症：臨床症状、診断、およびマネージメント choledocholithiasis clinical manifestations diagnosis and management

English Journal

[POSTCHOLECYSTECTOMY SYNDROME: CLASSIFICATION, THE RISK FACTORS, CRITERIA OF THE DIAGNOSIS ESTABLISHMENT, TREATMENT-DIAGNOSTIC ALGORITHM].

Nichitaylo MY, Zagriychuk MS, Gutsulyak AI, Gomon AV, Stokolos AV, Prysyazhnyuk VV.
Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny.Klin Khir.2016 Apr;(4):12-6.
Own experience of surgical treatment of patients for postcholecystectomy syndrome (PCHES) in a 2010 - 2015 yrs period was enlighten. The PCHES modified classification was adduced, the immediate and remote results of the patients' treatment were analyzed, technical aspects and peculiarities of perfor
PMID 27434946

Belching After Biliary Pancreatitis and Laparoscopic Cholecystectomy.

Cerkezovic M1, Tulumovic D2, Umihanic MM1.
Medical archives (Sarajevo, Bosnia and Herzegovina).Med Arch.2016 Apr;70(2):151-3. doi: 10.5455/medarh.2016.70.151-153. Epub 2016 Apr 1.
INTRODUCTION: Belching is often reported symptom. It is rarely an isolated disorder and mainly occurs within various gastroduodenal diseases.AIM: The aim is to show the great breadth of clinical symptoms of postcholecystectomy syndrome which should have a multidisciplinary therapeutic approach takin
PMID 27147793

Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

Amin A1, Zhurov Y1, Ibrahim G1, Maffei A1, Giannone J1, Cerabona T1, Kaul A1.
Case reports in surgery.Case Rep Surg.2016;2016:1896368. doi: 10.1155/2016/1896368. Epub 2016 Mar 7.
Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecys
PMID 27047698

Japanese Journal

A New Approach for the Treatment of Postcholecystectomy Syndrome : Hepatic Plexus Vagectomy

Guler Osman,Aydin Metin,Karaayvaz Muammer
Nagoya medical journal 41(3), 87-89, 1997-09
NAID 110000023795

Endoscopic therapy of postcholecystectomy Mirizzi syndrome

KODALI VP
Gastrointest. Endosc. 44, 86-90, 1996
NAID 30016612983

Postcholecystectomy Syndrome Mimicking Angina Pectoris Detected by the Morphine Provocation Test

OSAWA Hiroyuki,SAITO Muneyasu,FUJII Mikihisa,YAMANAKA Takeo,YAGINUMA Toshio
Internal medicine 34(1), 51-53, 1995-01
… Postcholecystectomy syndrome due to sphincter of Oddi spasm was diagnosed and her pain was relieved by endoscopic sphincterotomy.(Internal Medicine 34: 51-53, 1995) …
NAID 10006592587

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リンク元	「胆嚢摘出後症候群」「胆嚢摘出術後症候群」「胆嚢切除後症候群」「胆のう切除後症候群」「胆のう摘出後症候群」
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