Postcholecystectomy syndrome (PCS) describes the presence of abdominal symptoms after a cholecystectomy (gallbladder removal). Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases. The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions. A recent 2008 study 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. Non-biliary causes of PCS may be caused by a functional gastrointestinal disorder, such as functional dyspepsia.Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3). This can be treated with a bile acid sequestrant like cholestyramine, colestipol or colesevelam, which may be better tolerated. Presentation
Symptoms of postcholecystectomy syndrome may include:
Dyspepsia, nausea and vomiting. Flatulence, bloating and diarrhea. Persistent pain in the upper right abdomen. 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)
SeHCAT or other test for bile acid diarrhea

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.
Hallmark finding of disease is a widened mediastinum visualized on chest x-ray. Once clinical symptoms of anthrax induced mediastinitis appear, disease is nearly 100% fatal. Individuals with known exposure to spores may be treated prophylactically with antibiotics (fluoroquinolones or tetracycline) to prevent disease progression. Chronic
There are two types of fibrosing mediastinitis: granulomatous and non-granulomatous. Granulomatous mediastinitis is due to a granulomatous process of the mediastinal lymph nodes leading to fibrosis and chronic abscesses in the mediastinum. The most common causes are histoplasmosis and tuberculosis infections. Non-granulomatous fibrosing mediastinitis is caused by an idiopathic reaction to drugs and radiation therapy. Autoimmune disease and Behcets disease are also causes. Etiology
An observational retrospective study of 17 patients diagnosed with DNM found that the infections most often originated from neck infections including tonsillar abscess, pharyngitis, and epiglottitis. The study also found that most infections are poly-microbial. Often the culprits are usually Gram-positive bacteria and anaerobes, though rarely, Gram-negative bacteria are also present. This severe form represents 20% of acute mediastinitis cases. Diagnosis
Acute
Acute mediastinitis can be confirmed by contrast x-rays since most cases of acute mediastinitis are due to esophageal perforation. Other studies that can be used include endoscopic visualization, Chest CT scan with oral and intravenous contrast.With regards to CT Imaging, the extent of involvement of the mediastinum can be evaluated. Therefore, acute mediastinitis can be classified into three categories:
diffuse mediastinitis
isolated mediastinal abscess
mediastinitis or mediastinal abscess complicated by empyema or subphrenic abscess.