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Bile gets trapped when gallstones block the flow of bile out of your gallbladder. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. What is cholecystitis?Ĭholecystitis is an inflammation of the gallbladder. In my own practice, the initial assessment of patients with PCS must, of course, begin with a thorough and accurate history and physical examination of the patient. If this initial assessment is concerning for one of the many known physical causes of PCS, then I will usually ask the patient undergo several preliminary screening tests, which typically include blood tests to assess liver and pancreas function, a complete blood count, and an abdominal ultrasound. Based upon the results of these initial screening tests, some patients may then be advised to undergo additional and more sophisticated tests, including endoscopic ultrasound (EUS), upper or/and lower GI endoscopy (including, in some cases, ERCP, or endoscopic retrograde cholangiopancreatography), bile duct manometry, or CT or MRI scans, for example. (The decision to order any of these more invasive and more costly tests must, of course, be dictated by each individual patient’s clinical scenario.Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct. While it is impossible to predict which patients will go on to develop PCS following cholecystectomy, there are some factors that are known to increase the risk of PCS following surgery. These factors include cholecystectomy performed for causes other than confirmed gallstone disease, cholecystectomy performed on an urgent or emergent basis, patients with a long history of gallstone symptoms prior to undergoing surgery, patients with a prior history of irritable bowel syndrome or other chronic intestinal disorders, and patients with a history of certain psychiatric illnesses. In reviewing the extensive list of potential causes of PCS, it is evident that some causes of PCS are directly attributable to cholecystectomy, while many other etiologies are due to unrelated conditions that arise either prior to surgery or after surgery.

Tumors of the liver, bile ducts, pancreas, stomach, small intestine, colon, or rectum.Abnormal function or anatomy of the main bile duct sphincter muscle (the “Sphincter of Oddi”).Chronic pancreatitis or pancreatic insufficiency.Fatty changes of the liver or other liver diseases.Residual gallbladder or cystic duct remnant following surgery.Infection of the bile ducts (cholangitis), incisions, or abdomen.Stricture (narrowing) of the bile ducts.Retained gallstones within the bile ducts or pancreatic duct.Adhesions (internal scars) following surgery.Painful surgical scars or incisional (scar) hernias.

Excessive consumption of fatty and greasy foods.Abnormal flow of bile into the GI tract after removal of the gallbladder.Hypersensitivity of the nervous system of the GI tract.Bile gastritis (inflammation of the stomach).In reviewing the etiologies of PCS that have been described so far, both patients and physicians can gain a better understanding of how complex this clinical problem is: