Lithiase et dilatation du canal cystique résiduel : une forme étonnante de syndrome post-cholécystectomie

Au départ d’une situation clinique singulière, nous étudions le syndrome post-cholécystectomie : principales étiologies, procédures diagnostiques recommandées, armes thérapeutiques disponibles. Nous présentons l’histoire d’un patient de 62 ans, hospitalisé en raison de douleurs de l’hypocondre droit, 12 ans après cholécystectomie. Une véritable néo-vésicule sera visualisée lors du bilan d’imagerie, avec sanction chirurgicale à la clef. Nous confrontons les données de la littérature à la situation clinique vécue. L’atteinte lithiasique et l’inflammation du canal cystique résiduel sont des causes reconnues du syndrome post-cholécystectomie. L’échographie et/ou la tomodensitométrie permettent habituellement une première approche diagnostique. Le traitement endoscopique constitue le premier choix thérapeutique

(eng) [Lithiasis and cystic duct remnant dilatation: a surprising case of postcholecystectomy syndrome] Based on a peculiar clinical situation, this paper was aimed at exploring the postcholecystectomy syndrome (PCS). What are its main causes? Which diagnostic procedures are currently recommended in the scientific literature? Which therapeutic tools are available? We describe the case of a 62-year-old man, who was hospitalized for right hypochondrial pain 12 years after cholecystectomy. Imaging examination revealed a so-called neo-gallbladder, and surgical treatment was proposed to the patient. A cystic duct remnant, observed after cholecystectomy, has been defined by most authors as a residual duct >1cm in length. When the PCS is accounted for by this cystic duct stump, it is generally referred to as cystic duct remnant syndrome. This scenario may possibly account for up to 16% of all PCSs. The presence of stones in the cystic duct stump, along with inflammation of this cystic duct remnant, are recognized causes of PCS. Abdominal ultrasonography and/or CT scan usually provide first diagnostic indications, while endoscopy is considered as first-line treatment