Abstract
BackgroundSubtotal cholecystectomy in patients with severe acute cholecystitis is considered a “bailout” option when the safety of the bile duct cannot be guaranteed. However, subtotal cholecystectomy has a long-term risk of remnant cholecystitis. The appropriate management of remnant cholecystitis has not been fully elucidated.Case presentationCase 1 was a 66-year-old man who had undergone subtotal cholecystectomy 14 years prior to the development of remnant cholecystitis. We first performed endoscopic gallbladder drainage to minimize inflammation, and then proceeded with elective surgery. We performed a reconstituting procedure for the residual gallbladder due to significant adhesions between the cystic and common bile ducts. Case 2 was a 56-year-old man who had undergone subtotal cholecystectomy for abscess-forming perforated cholecystitis 2 years prior to the development of remnant cholecystitis. He underwent endoscopic drainage followed by complete remnant cholecystectomy 4 months later.ConclusionEndoscopic gallbladder drainage is a useful strategy to improve inflammation and reduce the risk of bile duct injury during remnant cholecystectomy.
Highlights
Laparoscopic cholecystectomy (LC) is the gold standard strategy for acute cholecystitis
We report two cases of residual cholecystectomy for remnant cholecystitis after subtotal cholecystectomy
Henneman et al reported only one bile duct injury in 625 laparoscopic subtotal cholecystectomies [4], suggesting that subtotal cholecystectomy may be useful as an aspect of reducing the risk of bile duct injury
Summary
Laparoscopic cholecystectomy (LC) is the gold standard strategy for acute cholecystitis. Case report #1 A 66-year-old male was admitted to the emergency department in our hospital for evaluation of fatigue and shaking chills He had undergone laparoscopic subtotal cholecystectomy 14 years prior necessitating mesh repair. We opened the remnant gallbladder and removed stones and the EGBD tube (Fig. 2a), sutured the cystic duct via the fenestrating procedure. Case report #2 A 56-year-old male was admitted to the emergency department of our hospital because of persistent abdominal pain He had undergone an open subtotal cholecystectomy and irrigation drainage for abscess-forming perforated cholecystitis 2 years previously. Elective surgery was performed 4 months after EGBD tube placement, at which point the patient had an improved white blood cell count of 5100 /μL and C-reactive protein of 0.05 mg/dL. The patient was discharged on post-operative day 7 without any complications
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