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Gallbladder attack after removal

The short answer

The gallbladder attack due to gallstones is commonly treated by gallbladder removal to avoid recurrence. However, researchers reported that patients could suffer from abdominal pain similar to that of a gallbladder attack even after gallbladder removal. In addition, post-cholecystectomy syndrome involves biliary colic or right upper quadrant abdominal pain with a variety of gastrointestinal symptoms similar to those in patients with gallbladder inflammation (cholecystitis) before cholecystectomy

Key facts

  • Several researchers reported cases of upper abdominal pain similar to that of gallbladder attack that occurred after gallbladder removal.
  • The post-cholecystectomy syndrome could be the cause of the upper abdominal pain after gallbladder removal.
  • The causes of post-cholecystectomy syndrome include biliary causes and extra-biliary causes.


What is a gallbladder attack?

Can gallbladder attack occur after gallbladder removal?

Gallbladder attack after gallbladder removal

Post-cholecystectomy syndrome

Symptoms of post-cholecystectomy syndrome

Causes of post-cholecystectomy syndrome

Treatment of post-cholecystectomy syndrome

What is a gallbladder attack?

Gallbladder attack:

gallbladder attack is a term commonly used to describe transient episodic gallbladder pain or the prolonged pain due to acute cholecystitis (often with fever), and other symptoms that are best treated in the hospital.

Biliary colic:

Biliary colic is a term used to define severe pain located in the upper abdomen or epigastrium lasting from 15 min to 5 hours. This pain occurs due to stone obstruction of the cystic duct or common bile duct of the biliary system. It commonly occurs after eating large, fatty meals that cause gallbladder contraction.

Can gallbladder attack occur after gallbladder removal?

The answer is yes. Gallbladder attack even after gallbladder removal

Several studies reported that the symptoms of a gallbladder attack even after cholecystectomy (gallbladder removal).

What is cholecystectomy?

Cholecystectomy is a common abdominal surgical operation performed to relieve the distressing symptoms and prevent complications of acute cholecystitis.

About 800,000 cholecystectomies are performed annually in the United States at a cost exceeding US$6 billion (Ref).

The majority of gallstones are asymptomatic. However, symptomatic gallstones involve what is known as a gallbladder attack or gallbladder pain which commonly indicates serious complications such as acute cholecystitis, pancreatitis, or migration of gallstones into your bile duct leading to bile duct stooges.

Usually, no recommended treatments for asymptomatic gallstones. However, removal of the gallbladder (cholecystectomy) is considered the gold standard treatment of gallstones.

Gallbladder attack after gallbladder removal

In most cases, gallstone symptoms are relieved after gallbladder removal. However, 6% to 30% of patients experience the same type of pain after gallbladder removal (Ref).

Moreover, patients with gallstones usually have other disorders that lead to symptoms that can be confused with gallstone symptoms. Symptoms persist in up to 50% of patients after gallbladder removal, strongly suggesting mistaken symptom attribution to gallstones is common (Ref).

study showed that 22% of the patients suffered from pain attacks 1 year after an uncomplicated laparoscopic cholecystectomy.

Another study involved 292 patients who underwent cholecystectomy for gallstones with a gallbladder attack. Researchers showed that one year after cholecystectomy, about 34 % of patients still suffered some abdominal pain and were referred back to the hospital for investigation and none of them has been shown to have a retained bile duct stone at a minimum follow-up of 5 years.

An old study reported that biliary colic remained in only 8% of patients in contrast to non-colicky pain in 32%.

British randomized trial reported that 19% of the patients experienced biliary pain five years after cholecystectomy.

study reports significant findings about mistakes in gallstone symptoms before gallbladder removal. This study showed that for patients having gallstones and gastroesophageal reflux diseases (GERD), or irritable bowel syndrome, these symptoms of gallstones could be confused with symptoms of other concurrent diseases. This could explain the persistent gallstone symptoms after gallbladder removal.

Post-cholecystectomy syndrome

It is the term used to describe the persistence of biliary colic or right upper quadrant abdominal pain with a variety of gastrointestinal symptoms similar to those in patients with gallbladder inflammation (cholecystitis) prior to cholecystectomy. These symptoms are manifested after undergoing a cholecystectomy (Ref).

The post-cholecystectomy syndrome can represent either a continuation of symptoms caused by gallbladder inflammation or gallstones or the development of new symptoms.

Also, this term includes the development of new gastrointestinal symptoms associated with gallbladder removals such as diarrhea and gastritis

This syndrome has been classified based on the onset of symptoms into two categories.

  • In early post-cholecystectomy syndrome symptoms predominately occur in the postoperative period.
  • Late post-cholecystectomy syndrome symptoms occur months to years after a cholecystectomy.
  • According to a study published in the Journal of Translation Gastroenterology and Hepatology as many as 40% of post-cholecystectomy patients are affected by this syndrome.

The symptoms of post-cholecystectomy syndrome include:

  • Fatty food intolerance,
  • Nausea,
  • Vomiting,
  • Heartburn,
  • Flatulence
  • Indigestion
  • Diarrhea
  • Jaundice
  • Intermittent episodes of abdominal pain.

Causes of the post-cholecystectomy syndrome:

The causes of the post-cholecystectomy syndrome are related to the biliary system and are called biliary causes, or the most common symptoms are extra-biliary in nature which may present before cholecystectomy and are called extra-biliary causes (Ref).

Biliary causes of the post-cholecystectomy syndrome

  • Biliary duct injury
  • Biliary leakage into the stomach
  • Retained cystic duct
  • Common bile duct stones
  • Bile salt-induced diarrhea.
  • Bile duct strictures
  • Recurrent common bile duct stones
  • Sphincter of Oddi dysfunction (a muscular valve that helps move bile and juices from your pancreas into your small intestine. When it doesn’t work right, it’s called sphincter of Oddi dysfunction)

Extra biliary causes include:

  • Gastroesophageal reflux diseases
  • Peptic ulcer disease
  • Irritable bowel syndrome
  • Acute and chronic pancreatitis

Treatment of post-cholecystectomy syndrome:

Pharmacological treatment

The goals of pharmacological treatments are to prevent complications and reduce morbidity. This includes the following treatment approaches:

  • Administration of bulking agents, antispasmodics, or sedatives may be beneficial in patients with irritable bowel syndrome
  • Cholestyramine may be helpful for patients with only diarrhea
  • For patients with Gastroesophageal reflux diseases (GERD ) or gastritis symptoms, antacids, histamine-2 blockers, or proton-pump inhibitors may provide relief from symptoms
  • Patients with dyspeptic symptoms correlated with the concentration of bile salts in the stomach these patients may benefit from bile acid binders such as cholestyramine.

Surgical treatments:

  • Surgery is a treatment option when there is a well-established cause known to respond to operative intervention.
  • In cases of post-cholecystectomy syndrome resulting from the remnant cystic duct, and bile duct stones, surgical excision of the remnant stones may be necessary in some cases.